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R534.Sm4  Sm4      The  memoirs  of  a  phy 


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THE  MEMOIRS  OF  A  PHYSICIAN 


THE   MEMOIRS 
OF  A  PHYSICIAN 


TRANSLATED  FROM 
THE  RUSSIAN  OF 
VIKENTY  VERESSAYEV 
By    SIMEON     LINDEN 

WITH  AN  INTRODUCTION  AND  NOTES 
BY    HENRY    PLEASANTS,     Jr.,     M.D. 


ALFRED  •  A  •  KNOPF 
NEW  YORK  '  MCMXVI 


COPYRIGHT,  1916,    BY 
ALFRED  A.  KNOPF 


PRINTED  IN  THE  UNITED  STATES  Qf  AMERICA 


EDITOR'S  INTRODUCTION 

In  reviewing  The  Memoirs  of  a  Fhysician  two 
important  problems  confront  us.  First:  Is  it 
true*?  Second:  If  it  be  true,  should  it  be  placed  be- 
fore the  American  public*? 

Let  us  answer  the  second  question  first.  Should 
we  hesitate  to  place  anything  that  is  true  before  those 
who  have  a  right  to  know'?  Assuredly  not.  Suc- 
cess in  Medicine  depends  to  a  great  extent  upon  the 
co-operation  of  physician  and  patient.  If  the  pa- 
tient remains  in  ignorance  of  the  essential  princi- 
ples that  underlie  the  treatment,  and  merely  follows 
blindly  a  course  outlined  because  it  is  so  ordered 
the  practice  of  medicine  must  savour  of  charlatan- 
ism. Such  a  condition  of  affairs  is  to  be  deplored. 
Medicine  should  no  longer  be  kept  what  it  was 
in  the  Middle  Ages — a  Black  Art,  its  mysteries 
known  (*?)  only  to  the  elect  few  who  have  studied 
its  text-books.  The  world  at  large  has  given  to  the 
profession  funds  to  be  used  in  establishing  hospitals, 
founding  medical  schools,  supporting  asylums,  di- 
recting medical  research,  and  doing  a  host  of  other 
things  pertaining  to  the  advancement  of  the  science. 
It  is  therefore  the  prerogative  of  our  profession  to 


vi  INTRODUCTION 

render  an  accurate  account  of  such  a  trust.  In  this 
The  Memoirs  of  a  Physician  has  succeeded.  It 
shows  how  earnestly  and  faithfully  physicians  have 
endeavoured  to  prove  worthy  of  the  trust  that  was 
imposed  on  them.  More  than  that  it  deals  with 
problems  that  a  physician  is  confronted  with  in  his 
daily  work,  it  has  frankly  emphasized  the  limita- 
tions of  the  knowledge  possessed  by  those  who  should 
know,  and  has  laid  bare  many  secrets  which  have 
heretofore  been  hidden  under  the  cloud  of  mystery 
that  has  ever  hung  over  the  walls  of  our  medical 
schools. 

In  America  many  of  the  same  problems  confront 
us,  and  the  question  is:  Can  we  place  these  prob- 
lems before  the  public  and  let  them  see  where  we 
have  failed  to  solve  them — made  hideous  mistakes? 
Fortunately  for  us  in  this  country  conditions  are  not 
the  same  as  those  in  Russia  twenty  years  ago. 
There  is  less  of  a  mystery  about  Medicine  on  this 
side  of  the  Atlantic. 

Advances  in  science  are  freely  discussed  in  the 
lay  press.  The  effort  has  been  to  educate  the  pub- 
lic in  medical  matters.  As  a  result,  laws  have  been 
enacted  relating  to  child  labour,  the  sale  of  narcotics, 
sanitation,  ventilation  of  factories,  etc.,  and  great 
good  has  been  done.  Public  spirited  men  and 
women  all  over  the  country  are  working  for  the  ad- 
vancement of  our  profession.  Will  it  alter  their 
view  point  if  they  know  that  ten  or  fifteen  years 


INTRODUCTION  vii 

ago  certain  science-mad  individuals  on  the  other  side    . 
.     .  .  .      J 

of  the   Atlantic   inoculated  healthy   children   with 

syphilis  to  prove  whether  or  not  the  disease  was  con- 
tagious in  the  secondary  stage?  No.  A  few  sen- 
sational sheets  will  pour  out  a  volley  of  anathemas 
at  the  profession.  The  Anti-vivisectionist  will  grab 
at  the  facts  disclosed  as  a  hungry  dog  would  a  bone 
and  use  those  facts  as  they  have  other  facts — unrea- 
sonably. The  thoughtful  man  will  read  deeper. 
He  will  take  the  problems  to  heart  and  help  to  solve 
them ;  he  will  note  the  limitations  of  the  medical  pro- 
fession and  seek  to  eliminate  them.  Americans  can 
read  this  book  and  profit  by  it. 

Let  us  now  consider  the  book  from  another  stand- 
point. Is  it  true?  Does  it  reflect  accurately  the 
life  and  thoughts  of  the  educated  physician?  In  a 
measure  it  does,  but  not  completely.  Suppose  we 
stand  on  a  high  mountain  overlooking  a  broad,  beau- 
tiful valley.  The  hill-tops  below  us  alone  catch  our 
eye,  the  ravines  and  swamps  between  the  hills  are 
invisible  or  appear  in  insignificant  patches  on  a 
superb  landscape.  We  are  impressed  with  the 
grandeur  of  the  scene  before  us.  Our  guide  leads 
us  down  into  the  valley  and  we  find  that  between 
the  hills  are  the  swamps  and  the  dark  ravines.  The 
hill-tops  are  no  longer  visible,  only  occasionally  as 
we  ascend  one  of  them  we  catch  glimpses  of  others 
rearing  their  heads  above  the  vast  stretches  of 
murky  lowlands  on  all  sides.     It  depresses  us,  and 


viii  INTRODUCTION 

we  long  for  the  ascent  to  the  heights  from  which 
we  shall  again  see  the  whole  valley.  So  it  is  with 
The  Memoirs  of  a  Physician,  We  have  been 
standing  on  the  heights  overlooking  the  Valley  of 
Mystery — Medicine.  Our  guide  takes  us  down  into 
the  Swamps  of  Adversity,  the  Ravines  of  Ignorance, 
the  Sloughs  of  Despond.  On  all  sides  rise  the 
little  Hills  of  Triumph  whose  crests  when  viewed 
from  above  made  the  Valley  beautiful,  but  how  piti- 
fully small  and  even  ugly  they  seem  surrounded  as 
they  are  by  the  vast  stretches  of  murky  lowlands. 
We  wish  to  be  taken  back  to  the  mountain  top,  but 
no,  our  guide  leaves  us  still  floundering  in  the  bogs, 
sorry  that  we  came. 

The  author  touches  many  raw  points.  He  views 
his  profession  with  the  eyes  of  a  man  discouraged 
and  disheartened.  He  shows  us  a  conscience  harassed 
and  troubled  by  conditions  which  he  feels  power- 
less to  improve.  There  is  no  physician  who  has 
any  sense  of  high  regard  for  the  feelings  of  his 
fellow  men,  who  has  not  experienced  similar  sen- 
sations when  he  has  been  confronted  with  acute  suf- 
fering that  he  is  unable  to  alleviate.  Nearly  every 
physician  has  at  one  time  or  other  seen  a  patient 
succumb  under  a  course  of  treatment  that  did  posi- 
tive harm.  But  the  truly  strong  man  will  take  such 
cruel  lessons  as  part  of  his  education.  He  will  take 
courage  from  the  thought  that  he  will  by  reason  of 
such  lessons  be  able  in  future  not  only  to  prevent 


INTRODUCTION  ix 

the  recurrence  of  such  accidents,  but  to  save  the  lives 
of  perhaps  a  score  of  others  who  would  have  perished 
had  the  mistake  not  occurred. 

It  seems  to  us  that  the  author  of  The  Memoirs 
of  a  Physician  does  not  realise  sufficiently  the  im- 
portance of  the  physician's  working  with  a  pa- 
tient rather  than  at  him.  There  is  not  so  much 
empiricism  in  medicine  as  there  was  ten  years  ago. 
Secrecy  of  methods  in  practice  has  been  relegated  to 
the  dim  past.  The  patient  of  to-day,  be  he  ever  so 
humble,  is  encouraged  to  study  principles  of  treat- 
ment, of  hygiene,  even  of  surgery  in  order  that  he 
and  his  physician  may  work  together  for  a  common 
end.  Doctor  and  patient,  in  America  certainly,  are 
drawing  closer  together  and  the  results  are  gratify- 
ing. The  careful  explanation  to  a  patient  as  to 
the  danger  of  contracting  such  a  disease  as  tubercu- 
losis by  living  under  unhygienic  conditions  and  con- 
tinuing to  keep  late  hours  carries  far  more  weight 
than  a  hastily  written  prescription  for  a  tonic.  Pa- 
tients are  not  slow  to  appreciate  thoroughness  of 
examinations  or  common  sense  in  treatment. 
Furthermore  it  is  remarkable  how  readily  the  rela- 
tives of  persons  succumbing  to  unusual  diseases  will 
allow  examinations  of  the  body  for  the  advance- 
ment of  science  once  they  are  tactfully  impressed 
with  the  importance  of  such  examinations.  Again, 
we  seldom  are  brought  face  to  face  with  the  ex- 
tremes of  hatred  or  gratitude  on  the  part  of  the 


X  INTRODUCTION 

relatives  that  the  author  dilates  upon  so  bitterly 
Perhaps  the  reason  for  this  is  that  we  have  taught 
our  patients  that  the  cure  of  a  given  disease  lies 
more  within  the  patient  himself  than  in  the  physi- 
cian. The  latter,  if  he  be  a  wise  man,  bends  his 
energies  toward  conserving  the  patient's  own  resis- 
tive powers  rather  than  dosing  him  with  "specifics." 
The  family  of  the  patient  are  satisfied  or  dissatis- 
fied according  to  the  thoughtful  attention  given  by 
the  doctor. 

It  would  seem  well  for  the  reader  to  take  these 
facts  into  careful  consideration  when  he  thinks  that 
the  author  has  left  him  floundering  in  the  bog  of 
hopeless  pessimism.  Let  him  return  to  the  moun- 
tain overlooking  the  Valley  of  Mystery  and  see  the 
Hills  of  Triumph  once  more  before  him.  There 
they  stand;  the  Wassermann  Reaction,  by  which 
Syphilis  may  be  detected  in  the  blood;  Ehrlich's 
Salvarsan  or  606,  the  specific  cure  for  the  same  dis- 
ease; Flexner's  Serum,  which  has  saved  the  lives 
of  hundreds  of  children  suffering  from  Cerebro-spi- 
nal  Meningitis;  the  typhoid  bacterin,  which  renders 
the  individual  immune  from  typhoid  fever  for  a  con- 
siderable time;  the  fresh  air  treatment  of  tuberculo- 
sis; Radium;  Organo-therapy,  and  a  host  of  others. 

Time  does  not  allow  of  the  discussion  of  the  va- 
rious problems  brought  to  light  in  the  book  which 
we  do  not  hesitate  to  present  to  the  American  people 
whom  we  trust  to  read  it  carefully  and  thoughtfully, 


INTRODUCTION  xi 

and  after  due  deliberation  to  render  our  profession 
their  aid  in  solving  our  problems,  correcting  our  mis- 
takes and  draining  the  Sloughs  of  Despond  in  the 
Valley  of  Mystery. 

Finally  let  us  consider  the  book  from  another 
standpoint.  Conscience  is  its  keynote.  It  is  the  re- 
flection of  the  conscience  of  a  philosopher  who  has 
opened  the  inner  doors  of  the  hiding  places  of  sci- 
ence and  is  bewildered  by  what  he  has  found. 
There  is  an  indescribable  pathos  in  some  of  his  de- 
scriptions. One  hears  the  cry  of  an  agonised  soul 
for  help  to  accomplish  a  task  that  is  beyond  its  own 
powers. 

The  book  views  the  future.  It  apprehends  a  re- 
volt against  Science  for  Science  and  prays  for  Sci- 
ence for  Humanity  alone.  It  shows  what  crimes 
may  be  committed  if  science  is  allowed  to  run  riot  in 
the  course  of  experimentation,  yet  it  shows  too  what 
desperate  need  there  is  for  properly  conducted  in- 
vestigation that  may  lead  to  the  alleviation  of  suf- 
fering. 

Henry  Pleasants,  Jr. 

April  1st,  1916. 


AUTHOR'S  INTRODUCTION 

Seven  years  ago  I  completed  my  studies  at  the 
Faculty  of  Medicine.  The  knowledge  of  this  fact 
will  prepare  the  reader's  mind  for  what  is  to  follow. 

My  reminiscences  are  not  those  of  an  old,  experi- 
enced physician  summarising  the  results  of  his  life- 
long observations  and  reflections,  having  evolved 
definite  answers  to  all  the  complex  questions  of 
medical  science,  its  ethics  and  the  exercise  of  its 
profession.  Also,  they  are  not  those  of  a  physician 
and  philosopher  who  has  deeply  penetrated  into  the 
essence  of  his  science  and  completely  mastered  it. 

I  am  but  an  average  practitioner,  with  average 
ability  and  average  knowledge.  I  find  myself  en- 
tangled in  a  web  of  contradictions,  and  I  am  utterly 
powerless  to  solve  many  of  the  hard  problems  which, 
importunately  demanding  an  answer,  arise  before 
me  at  every  step.  The  only  advantage  I  possess 
lies  in  the  fact  of  my  not  having  had  time  to  become 
a  pure  professional,  and  that  those  impressions,  to 
which  one  involuntarily  becomes  inured  in  time, 
have,  in  my  case,  still  retained  their  freshness,  their 
power  and  their  vividness.  I  am  about  to  describe 
my  sensations  on  my  first  acquaintance  with  medi- 


xiv  INTRODUCTION 

cine,  what  I  expected  of  it,  and  how  it  actually 
affected  me;  I  will  write  of  my  first  independent 
steps  on  the  high  road  of  my  professional  career,  of 
the  impressions  I  obtained  from  my  practice.  I 
will  endeavour  to  set  down  all^  hiding  nothing,  and 
I  will  strive  to  write  with  absolute  frankness. 

The  Author. 


CONTENTS 

CHAFTEK  rAGX 

EDITOR'S  INTRODUCTION  v 

AUTHOR'S  INTRODUCTION  xiii 

I    THE  FRAILTY  OF  THE  HUMAN  BODY  i 

II    EXAMINATION  AND  AUTOPSY  15 

III  WHAT   MEDICINE   HAS   NOT  ACCOMPLISHED 

AND  WHAT  IT  HAS  34 

IV  THE    DIFFICULTIES    THAT    CONFRONT    THE 

YOUNG  PRACTITIONER  57 

V    YOUNG  DOCTORS  AND  TECHNIQUE  78 

VI    THE  ART  AND  INEVITABLE  RISKS  OF  SURG- 
ERY 84 

VII    IN    MEDICINE—NOTHING    RISKED,    NOTHING 

GAINED  104 

VIII  MEDICINE  AN   ART;   NOT  A   SCIENCE  123 

IX  THE  QUESTION  OF  VIVISECTION  141 

X  THE  UNCERTAINTY  OF  DIAGNOSIS  159 

XI  DOCTOR  AND  PATIENT  174 

XII  THE  DOCTOR  AND  THE  POOR  188 

XIII  MEDICINE,    NATURAL    SELECTION    AND    THE 

SURVIVAL  OF  THE  UNFIT  200 

XIV  MENTAL   PROGRESS   AND   PHYSICAL   DEGEN- 

ERATION  (RETROGRESSION)  214 

XV    SHAME  AND  THE  PHYSICIAN  228 

XVI    WHEN  THE  PATIENT  DIES  241 

XVII    "THE  PROFESSIONAL  MANNER"  256 

35V 


CONTENTS 

CHAPTER  PAGE 

XVIII    DOCTORS  AND  MONEY  267 

XIX    DOCTORS  AND  THE  LAW  285 

XX    THE  MARKET  FOR  DOCTORS  299 

XXI    THE  DOCTOR'S  STRUGGLE  306 

APPENDIX  A  (Editor's  Notes)  314 

APPENDIX  B  (Experiments  on  Living  Men  and  Women)  332 

AUTHOR'S  POSTSCRIPT  367 


THE  MEMOIRS  OF  A  PHYSICIAN 


THE  MEMOIRS  OF  A 
PHYSICIAN 

CHAPTER  I 

THE    FRAILTY    OF    THE    HUMAN    BODY 

I  STUDIED  with  diligence  while  at  the  Gym- 
nasium and  was  considered  a  good  scholar,  but 
in  common  with  the  majority  of  my  fellows,  I  held 
the  curriculum  of  my  school  in  the  greatest  con- 
tempt. Those  studies  oppressed  me  as  an  irksome 
and  distasteful  burden,  in  itself  lacking  all  personal 
interest,  but,  for  some  reason,  essential  for  me  to 
carry.  What  did  I  care  about  the  date  of  canonisa- 
tion of  some  obscure  Byzantine  Saint,  the  parentage 
of  Otto  the  Great  or  the  passive  conjugation  of 
persuade 0  tihi?  The  advance  of  my  mental  de- 
velopment was  quite  independent  of  my  school,  and 
it  was  outside  school  hours  that  I  accumulated  the 
knowledge  of  those  facts  which  interested  me.  But 
all  this  underwent  a  sharp  change  as  soon  as  I  be- 
came a  student  at  the  University.  The  first  two 
years  at  the  Faculty  of  Medicine  are  devoted  to 
theoretical  study  of  the  various  branches  of  natural 


,  2      THE  MEMOIRS  OF  A  PHYSICIAN 

science:  chemistry,  physics,  botany,  zoology  and 
physiology.  I  was  entirely  carried  away  by  these 
subjects — so  new  and  so  important  to  me  was  the 
information  they  imparted.  All  the  phenomena 
which  surrounded  me  and  filled  me,  which  I  con- 
templated before  with  the  eyes  of  a  savage,  now 
became  plain  and  comprehensible;  and  I  was  sur- 
prised that  I  should  have  lived  to  the  age  of  twenty 
without  any  knowledge  of,  or  interest  in,  those  facts. 
Every  day,  every  lecture  brought  new  "discoveries" 
in  their  wake  and  I  was  astounded  to  learn,  for  in- 
stance, that  the  meat  I  ate  in  the  form  of  beef-steaks 
and  cutlets  was  that  mysterious  matter  called 
"muscle,"  which  hitherto  my  imagination  had 
vaguely  pictured  as  balls  of  greyish  thread ;  formerly 
I  thought  that  solid  food  left  the  stomach  for  the 
intestines,  and  the  fluid — for  the  kidneys;  it  appeared 
to  me  that  in  breathing  my  chest  expanded  because 
some  inexplicable  force  introduced  the  outside  air; 
I  was  cognisant  of  the  laws  of  conservation  of  mat- 
ter and  energy,  but  in  my  heart  of  hearts  did  not 
believe  in  them.  Afterwards  I  made  the  discovery 
that  most  so-called  educated  people  retained  no  less 
childish  conceptions  in  regard  to  all  that  lay  within 
their  vision,  and  were  not  discomfited  by  the  fact. 
They  will  blush  for  shame  if  unable  to  name  the 
century  of  Louis  XIV.,  but  are  not  in  the  least 
disconcerted  when  it  comes  to  displaying  their 
ignorance  as  to  the  process  of  asphyxiation  or  the 


FRAILTY  OF  THE  HUMAN  BODY       3 

reasons  for  the  luminosity  of  phosphorus  placed  in 
the  dark. 

In  regard  to  anatomy,  one  often  has  to  hear  of 
the  unpleasant  and  repulsive  side  of  its  study,  owing 
to  the  necessity  of  dissecting  and  preparing  dead 
bodies.  Certainly,  many  of  my  comrades  took  some 
time  to  become  accustomed  to  the  sight  of  'the 
anatomical  theatre,  filled  with  mutilated  corpses  with 
glassy  eyes,  grinning  teeth,  and  claw-like  fingers; 
one  of  them  even  had  to  repudiate  medicine,  and 
take  up  another  branch  of  learning;  he  began  to 
have  hallucinations — to  his  disordered  imagination 
at  night  his  room  seemed  to  fill  with  corpses,  and 
from  every  corner  bleeding  limbs  crawled  towards 
his  bed. 

For  my  part  I  very  soon  became  familiarised  with 
the  corpses  and  used  to  sit  for  hours  engrossed,  heart 
and  soul,  in  their  preparation,  which  laid  all  the 
secrets  of  the  human  body  open  before  me.  For 
seven  or  eight  months  I  devoted  myself  entirely  to 
the  study  of  anatomy, — and  for  the  time  being  my 
views  on  mankind  became  wonderfully  simple. 

When  walking  in  the  street  watching  a  pedestrian 
in  front  of  me,  I  saw  in  him  but  an  animated  corpse ; 
now  his  glutaeus  maximus  would  contract,  then  his 
quadriceps  femoris;  that  swelling  of  the  neck  de- 
noted a  strong  development  of  the  sternocleidomas- 
toid eus  muscle.  If  he  dropped  his  walking  stick  and 
bent  down  to  lift  it  up,  I  knew  that  the  musculi 


4      THE  MEMOIRS  OF  A  PHYSICIAN 

recti  ahdominalis  had  contracted,  drawing  his  thorax 
down  towards  the  pelvis.  People  who  were  near 
and  dear  to  me  seemed  to  assume  a  dual  quality: 
that  young  girl  for  instance — there  is  so  much 
originality  and  attractiveness  about  her!  When  in 
her  presence  I  feel  happy  and  light  of  heart,  but 
at  the  same  time  all  that  goes  to  make  her — is  well 
known  to  me,  and  there  is  really  nothing  extraordi- 
nary about  her :  her  brain  is  corrugated  by  the  same 
convolutions,  such  as  I  have  seen  upon  hundreds 
of  brains;  her  muscles  are  permeated  through  and 
through  with  fat — which  makes  the  dissection  of 
feminine  corpses  such  an  unpleasant  task;  in  a  word, 
there  is  really  nothing  in  her  either  attractive  or 
suggestive  of  poetry. 

But  I  was  even  more  powerfully  impressed  by 
the  method  which  reigned  in  this  new  knowledge, 
than  by  what  that  knowledge  offered  me  in  itself. 
It  led  one  forward  carefully,  with  circumspection, 
but  without  wavering,  without  leaving  the  most 
insignificant  detail  unverified  or  uncontrolled  at 
every  step  with  the  most  painstaking  severity  by 
experiment  and  observation;  and  what  had  once 
been  passed  was  passed  finally,  without  there  being 
the  slightest  chance  of  the  necessity  arising  for 
the  retracing  of  one's  steps.  This  method  was 
all  the  more  fascinating  because  it  had  nothing  in 
common  with  the  class-room  rules  of  abstract  logic; 
it  was  the  necessary  outcome  of  the  very  matter  in 


FRAILTY  OF  THE  HUMAN  BODY       5 

hand.  Every  fact,  every  explanation  of  a  fact 
seemed  to  exemplify  the  golden  words  of  Bacon: 
Non  fingendum  aut  excogitandum^  sed  inveniendum^ 
quid  natura  facial  aut  ferat.  No  need  even  to  know 
of  the  existence  of  logic — science  itself  would  force 
one  to  acquire  its  method  more  effectually  than  the 
most  exhaustive  treatise  on  methods!  It  educated 
one's  mind  in  such  a  manner  as  to  make  all  devia- 
tion from  its  straight  path  a  sheer  impossibility. 

With  the  closing  of  the  last  term  of  my  second 
year,  these  theoretical  studies  came  to  an  end.  I 
passed  my  intermediary  examination,  and  our 
clinical  work  then  began. 

The  whole  character  of  the  knowledge  to  be  ac- 
quired underwent  a  radical  change.  Instead  of  ab- 
stract science,  living  man  came  to  the  fore;  the 
theories  of  inflammation,  microscopical  preparations 
of  tumours  and  bacteria,  gave  place  to  real  wounds 
and  sores.  An  endless  procession  of  sick,  maimed 
and  suffering  humanity  began  to  pass  before  one's 
eyes.  Slight  cases  are  not  admitted  to  the  Uni- 
versity hospitals;  and  here  the  sufferings  were  real 
and  grave.  Their  abundance  and  variety  had  a 
benumbing  effect  on  me;  I  was  struck  by  the  im- 
mensity of  existing  suffering,  at  the  great  multi- 
tude and  variety  of  the  different  forms  of  the  most 
refined,  incredible  tortures  prepared  for  us  by  nature 
— torments,  the  very  sight  of  which  made  one's  soul 
sick. 


6      THE  MEMOIRS  OF  A  PHYSICIAN 

Soon  after  the  commencement  of  our  clinical 
studies,  a  market  gardener  with  lock-jaw  was 
brought  into  the  senior  students'  ward.  We  went 
to  look  at  him.  Stillness  reigned  in  the  big  room. 
The  sufferer  was  a  thick  set  and  muscular  sun- 
tanned working  man  of  gigantic  stature;  bathed  in 
sweat,  with  lips  distorted  from  the  hideous  agony, 
with  rolling  eyes,  he  lay  on  his  back.  At  the  slight- 
est noise — when  a  tram  bell  rang  in  the  street  below 
or  a  door  slammed,  the  sick  man  began  to  bend 
out  slowly:  the  nape  of  his  neck  was  drawn  down, 
his  jaw  convulsively  locked  together,  until  the  teeth 
cracked  audibly,  and  a  terrible,  prolonged  convul- 
sion of  the  dorsal  muscles  lifted  the  body  from 
the  bed,  while  a  large  moist  spot  of  perspiration 
gradually  spread  over  his  pillow  away  from  his 
head.  A  fortnight  before,  while  he  was  at  work 
bare-footed  amongst  his  vegetable  beds,  a  splinter 
entered  his  big  toe;  that  insignificant  particle  of 
wood  had  been  the  cause  of  what  I  now  saw  before 
me. 

The  mere  fact  of  the  existence  of  such  frightful 
sufferings  was  not  the  most  terrible  side  to  the  ques- 
tion; the  ease  with  which  they  could  be  acquired, 
and  the  absence  of  guarantee  against  them  for  the 
healthiest  of  men,  were  what  appalled. 

A  fortnight  ago  any  one  would  have  envied  that 
very  same  gardener  his  splendid  health  and  phy- 
sique.    A  strapping  young  ostler,  in  passing  across 


FRAILTY  OF  THE  HUMAN  BODY      7 

his  stable-yard,  slipped  and  struck  his  back  against 
a  trough.  For  six  years  up  to  this  date  he  has  been 
in  our  clinic;  his  legs  hang  lifeless  as  wisps  of 
straw,  he  cannot  move  them,  and  he  passes  water 
and  evacuates  unconsciously.  Helpless  as  a  babe 
in  arms,  there  he  lies  on  his  back  for  da3^s,  months, 
years,  lies  until  he  develops  bed-sores,  and  there 
is  no  hope  of  his  ever  regaining  a  particle  of  his 
former  vigour.  ...  A  government  clerk  with  in- 
flammation of  the  ischiatic  nerve,  goaded  to  mad- 
ness by  his  sufferings,  yells  at  the  professor: — 

*'0h,  you  miserable  quacks  I  Kill  me,  for  God's 
sake,  kill  me,  that  is  all  I  beg  of  you  I" 

One  fine  summer's  evening  he  had  rested  on  the 
dewy  grass. 

Every  moment  and  at  every  step  we  are  warned 
of  all  manner  of  dangers;  to  defend  ourselves  were 
in  vain  because  they  are  too  varied,  flight  is  useless 
because  they  are  everywhere.  Even  when  we  are 
in  a  state  of  health,  our  organism  is  not  quiescent; 
in  swallowing,  in  breathing,  billions  of  bacilli  find 
an  entrance  into  our  bodies;  the  most  deadly 
poisons  are  generated  without  intermission;  un- 
noticed all  our  vital  powers  wage  remorseless  war 
with  injurious  substances  and  influences,  and  we 
dare  not  for  a  moment  consider  ourselves  safe- 
guarded against  the  possibility  of  our  internal  forces 
proving  inadequate  in  this  endless  struggle.  And 
when  this  happens,  our  cause  is  lost;  a  small  abrasion 


8      THE  MEMOIRS  OF  A  PHYSICIAN 

develops  Into  erysipelas  or  a  phlegmon,  or  causes 
blood-poisoning;  a  slight  bruise  results  in  the  for- 
mation of  cancer  or  sarcoma;  a  trifling  attack  of 
bronchitis  contracted  through  exposure  to  a  draught, 
ends  in  consumption.  .  .  .  Ideal  and  exceptional 
circumstances  of  existence  would  be  required  to 
make  sickness  a  "chance"  occurrence;  as  things  stand 
at  present  all  suffer  from  disease:  the  poor  because 
of  their  want,  the  rich  owing  to  their  superfluity; 
workers  because  their  strength  is  overtaxed,  drones 
by  reason  of  their  idleness;  the  careless  as  a  result 
of  their  carelessness,  the  cautious  because  of  their 
over-caution. 

Decay  lies  hidden  in  man  from  the  tenderest  age, 
his  body  begins  to  decompose  before  it  has  even  had 
time  to  complete  its  development.  In  Boston  the 
mouths  of  four  thousand  school  children  were  ex- 
amined and  it  was  found  that  healthy  teeth,  espe- 
cially in  children  of  over  ten  years  of  age,  were  an 
exception.  In  Bavaria  only  three  children  were 
found  to  have  perfectly  sound  teeth  out  of  a  total 
of  five  hundred  pupils  of  the  elementary  schools 
that  were  examined.  Dr.  Babes  dissected  one  hun- 
dred infantile  corpses,  and  in  the  case  of  seventy- 
four  he  found  tubercle  bacilli  in  the  bronchial 
glands;  all  those  children  had  died  of  non- tubercular 
diseases.  Children  wake  with  "sleepy"  suppurat- 
ing eyes ;  from  childhood  we  all  begin  to  suffer  from 
chronic  nasal  catarrh  and  cannot  dispense  with  a 


FRAILTY  OF  THE  HUMAN  BODY      9 

pocket  handkerchief;  for  a  healthy  man  a  pocket 
handkerchief  is  superfluous,  but  this  simple  truth 
will  astonish  most  people.  As  for  women  who  have 
reached  the  age  of  puberty,  they  are  normally  and 
physiologically  condemned  to  be  ill  for  several  days 
each  month. 

I  began  to  regard  the  people  surrounding  me 
with  a  new  and  strange  feeling,  and  I  was  more  and 
more  struck  by  the  rarity  in  their  midst  of  healthy 
individuals;  nearly  every  one  of  them  had  some 
ailment.  To  me  the  world  began  to  assume  the 
aspect  of  one  gigantic  infirmary:  normal  man  was 
sick  man;  the  healthy  person  merely  represented  a 
happy  freak,  a  sharp  deviation  from  the  normal; 
this  fact  was  ever  becoming  more  plain.  When  I 
first  entered  upon  the  theoretical  study  of  obstetrics 
and  commenced  the  perusal  of  my  text-book,  I  re- 
mained engrossed  in  it  that  whole  night,  unable  to 
withdraw  my  attention  from  the  subject.  The  pic- 
ture of  the  "normal,"  the  "ph3^siological"  process 
of  parturition  unfolded  itself  before  me  like  an  op- 
pressive and  feverish  nightmare.  .  .  . 

I  remember  the  first  confinement  at  which  I  was 
present,  as  if  it  had  occurred  but  yesterday. 

"Tut,  tut,  ma'am,  try  and  bear  it  quietly!"  the 
assistant  house-surgeon  remarked  in  the  calmest  of 
voices. 

The  night  dragged  out  endlessly.  The  labouring 
woman  had  long  abandoned  all  efforts  at  self-con- 


lo    THE  MEMOIRS  OF  A  PHYSICIAN 

trol;  her  moans  filled  the  ward,  while  she  sobbed, 
trembled  and  clasped  her  clenched  hands ;  her  groans 
could  be  heard  in  the  passages  and  were  lost  far 
away  in  the  great  building.  After  an  unusually 
painful  access  of  the  throes,  catching  hold  of  the 
assistant's  hand,  pale,  with  a  face  racked  by  the 
agony,  she  looked  at  him  with  a  piteous  and  be- 
seeching glance. 

"Doctor,  tell  me,  shall  I  die*?"  she  asked  in  mortal 
fear. 

In  the  morning  her  husband,  agitated  and  nerv- 
ous, came  to  the  hospital,  to  inquire  after  his  wife's 
condition.  I  regarded  him  with  a  feeling  of  odium ; 
this  was  his  second  child;  therefore  he  knew  that 
his  wife  had  to  go  through  this  torment,  and  still 
he  remained  undeterred  by  the  knowledge.  .  .  . 

"This  was  an  easy  case  of  confinement,  and  of 
small  interest,"  remarked  the  surgeon. 

All  this  was  "normal"  too.  And  civilisation 
could  not  be  held  responsible  for  having  made  child- 
birth more  difficult:  women  always  gave  birth  in 
torment  and  the  ancients  were  struck  by  this  strange 
phenomenon  and  could  only  explain  it  as  the  curse 
of  God. 

Such  impressions  as  the  above  weighed  the  soul 
down  and,  following  each  other  without  intermis- 
sion, intensified  the  general  sombre  colouring  of 
everything  around  me. 

One  night  I  woke  up.     I  had  dreamt  of  being 


FRAILTY  OF  THE  HUMAN  BODY     ii 

run  over  by  a  carriage  while  traversing  a  narrow 
and  dark  alley;  the  pole  struck  me  in  the  side,  and 
pneumothorax  had  supervened.  I  sat  up  in  bed. 
The  pale  night  stared  me  in  the  face  through  the 
window,  a  cricket  kept  up  its  monotonous  chirping 
behind  the  stove;  somewhere  in  the  house  I  could 
hear  my  landlady's  sick  child  crying  fitfully.  All 
that  I  had  seen  and  brooded  over  of  late  came  home 
to  me  with  a  sudden  clearness,  and  I  was  appalled 
to  see  how  utterly  human  life  lacks  all  protection 
against  extraneous  chances,  and  on  what  a  slender 
thread  man's  health  depends.  If  only  it  were  pos- 
sible to  keep  one's  health!  with  such  a  reserve  no 
trials  could  have  any  real  terrors.  Its  loss  meant 
loss  of  one's  all;  without  health  there  could  be  no 
freedom,  no  independence,  a  man  becomes  the  slave 
of  those  who  surround  him,  of  his  environment ;  it  is 
the  highest  and  most  inestimable  of  all  blessings  and 
it  is  so  difficult  to  retain  it !  To  try  and  do  so  were 
to  consecrate  one's  whole  existence,  all  one's 
strength,  to  the  attainment  of  the  one  object;  but 
how  ridiculous,  how  insulting  to  one's  self-esteem, 
were  such  an  aim  in  life!  And  after  all,  it  would 
be  of  small  avail,  even  if  we  were  to  live  to  that 
sole  end!  Supposing  that  we  were  ever  on  our 
guard;  loss  of  adaptability  would  result.  And 
wherein  ought  our  precautions  lie?  We  are  ab- 
solutely ignorant  of  the  origin  of  cancer,  sarcoma, 
a   multitude   of   nervous   affections,    diabetes,    the 


12    THE  MEMOIRS  OF  A  PHYSICIAN 

majority  of  the  painful  diseases  which  attack  the 
skin,  and  so  on. 

It  is  quite  within  the  bounds  of  possibility,  no 
matter  how  careful  I  may  be  in  the  interval,  that  a 
year  hence  you  will  find  me  struck  down  by  pemphigo 
foUaceo^  a  disease  which  causes  the  skin  to  blister; 
these  blisters  burst,  lay  the  subcutaneous  surface 
bare  and  heal  no  more,  so  that  the  sufferer,  deprived 
of  his  skin,  can  neither  lie  down  nor  sit  up,  for  the 
slightest  touch  causes  burning  agony.  Very  likely 
you  will  call  me  ridiculous!  But  remember  that 
the  man  with  pemfhigo  foUaceo^  whom  I  saw  in  the 
clinic  the  other  day,  was  hale  and  hearty  and  free 
from  misgivings  half  a  year  ago!  We  are  not  as- 
sured of  a  single  hour  of  health.  At  the  same  time 
we  all  want  to  live,  to  live  and  be  happy — and  this 
is  denied  us.  .  .  .  And  why  does  love  exist  with 
all  its  poetry  and  bliss*?  Why  should  there  be  such 
a  thing  as  love  if  it  causes  so  much  torment?  Can 
it  be  that  "love"  is  not  a  cruel  mockery  of  love,  if 
a  man  has  it  in  him  to  cause  the  woman  he  adores 
such  sufferings  as  I  had  witnessed  in  the  lying-in 
hospital?  Suffering,  suffering  without  end,  in  every 
shape  and  form — it  is  thus  that  the  essence  of  the 
entire  life  of  the  human  organism  may  be  summed 
up. 

Such  was  the  gist  of  my  cheerless  reverie  during 
the  small  hours  of  the  morning.  I  had  not  long  to 
wait  before  I  had  a  personal  experience  which  seemed 


FRAILTY  OF  THE  HUMAN  BODY     13 

to  bear  out  the  above.  A  small  mole  under  my  left 
arm-pit,  without  any  apparent  cause,  suddenly  began 
to  increase  in  size  and  become  painful.  I  was  afraid 
to  believe  the  evidence  of  my  senses,  but  it  grew  and 
grew,  and  hurt  me  more  every  day.  At  last  the 
swelling  attained  the  size  of  a  hazel-nut.  There 
was  no  room  for  further  doubt:  the  mole  had  de- 
veloped into  a  sarcoma,  that  terrible  melano  sarcoma 
which  generally  originates  from  innocent-looking 
beauty  spots.  I  went  to  attend  the  consulting  hours 
of  our  professor  of  surgery,  feeling  as  if  I  were 
about  to  have  a  final  interview  with  the  hangman. 

"Professor,  I  believe  ...  I  have  a  sarcoma  of 
the  arm,''  I  said  in  an  unsteady  voice. 

The  professor  scrutinised  me  attentively. 

"Are  you  a  medical  student  of  the  third  course"?" 

"Yes." 

"Show  me  your  sarcoma!" 

I  undressed.  The  professor  removed  the  growth 
by  severing  its  narrow  stem  with  a  pair  of  scissors. 

"Your  sleeve  had  merely  irritated  the  mole,  noth- 
ing more.  Take  your  sarcoma  with  )^ou  as  a  keep- 
sake!" he  said,  smiling  good-naturedly  and  hand- 
ing me  a  small  fleshy  pellet. 

I  went  away  happy,  although  much  ashamed,  and 
I  felt  abashed  at  my  childish  apprehensiveness. 
But  soon  afterwards  I  began  to  notice  that  something 
abnormal  was  taking  place  within  me :  I  experienced 
a  general  lassitude  and  distaste  for  work,  I  lost  my 


14    THE  MEMOIRS  OF  A  PHYSICIAN 

appetite  and  I  constantly  suffered  from  thirst.  I 
lost  flesh  too,  and  every  now  and  then  abscesses 
formed  on  different  parts  of  my  body;  I  passed  water 
very  abundantly;  I  tested  it  for  sugar — it  contained 
none.  All  these  symptoms  pointed  to  diabetes  in- 
sipidus. In  deep  dejection  I  perused  the  chapter 
devoted  to  that  disease  in  Strumpell's  text-book: 
"The  causes  of  diabetes  insipidus  still  remain  quite 
obscure.  .  .  .  Most  sufferers  are  either  young  or 
of  middle  age,  men  are  somewhat  more  subject  to 
the  disease  than  women.  .  .  .  The  relationship  be- 
tween this  disease  and  diabetes  proper  is  obvious, 
and  the  one  has  been  known  to  pass  into  the 
other.  .  .  .  The  disease  may  continue  for  years  and 
even  decades,  and  cures  are  extremely  rare.  ..." 

I  went  to  our  professor  of  therapeutics.  With- 
out telling  him  of  my  fears,  I  simply  detailed  my 
symptoms.  As  I  proceeded  the  professor's  brows 
contracted  more  and  more. 

He  cut  me  short. 

"You  suppose  that  you  have  diabetes  insipidus. 
It  is  very  praise-worthy  that  you  should  have  studied 
Strumpell  so  painstakingly;  you  have  not  omitted  a 
single  symptom.  I  hope  you  will  be  as  well  up  in 
the  subject  when  the  examinations  come  round. 
Smoke  less,  eat  more,  take  more  exercise  and  leave 
off  thinking  of  diabetes." 


CHAPTER  II 

EXAMINATION    AND    AUTOPSY 

WE  were  now  obliged  to  study  the  sufferings 
of  living  men ;  but  at  first  it  was  not  so  much 
the  sight  of  these,  as  the  fact  of  our  having  to  make 
them  the  subject  of  study,  that  was  the  most  dis- 
tressing. Let  me  illustrate  my  meaning:  a  patient 
with  a  dislocated  shoulder  is  affected  by  heart 
disease;  chloroform  cannot  be  administered,  and  the 
shoulder  is  reset  without  ansesthetic;  the  hospital  at- 
tendants hold  the  patient  tightly,  he  struggles  and 
screams  from  pain;  at  the  same  time  one  has  to 
give  one's  full  attention  to  the  professor's  manipula- 
tions in  returning  the  limb  to  its  proper  position, 
one  must  remain  deaf  to  the  cries  of  the  man  being 
operated  upon,  blind  to  the  agonised  contortions  of 
his  tortured  body,  one  has  to  choke  down  one's  feel- 
ings of  sympathy,  and  control  one's  agitation.  This 
was  very  difficult  until  one  got  used  to  such  scenes, 
attention  invariably  becoming  divided;  it  was  con- 
stantly necessary  to  repeat  to  oneself:  ''I  am  per- 
fectly well,  it  is  not  I  but  another  person  who  is 
being  hurt." 


i6    THE  MEMOIRS  OF  A  PHYSICIAN 

Torrents  of  blood  during  operations,  the  groans 
of  labouring  women,  the  convulsions  of  patients 
with  lock-jaw — in  the  beginning  all  these  jarred 
upon  the  nerves  badly,  and  interfered  with  one's 
work.     Habit  had  to  be  acquired. 

However,  this  habit  comes  sooner  than  might  be 
thought,  and  I  know  no  case  of  a  medical  student, 
who  had  once  got  over  the  dissecting  of  corpses, 
leaving  the  field  of  medicine  because  he  could  not 
get  used  to  the  sound  of  groans  and  the  sight  of 
blood.  And  Heaven  be  praised  that  this  should 
be  so,  because,  without  a  doubt,  such  comparative 
"hardening"  is  both  essential  and  desirable. 

However,  the  study  of  medicine  on  the  living 
patient  has  another  side,  in  dealing  with  which  we 
are  confronted  by  what  is  infinitely  more  complex 
and  painful,  where  there  is  far  more  room  for  ques- 
tion and  doubt.  We  learn  from  the  patient;  to 
enable  us  to  do  so,  the  doors  of  the  clinics  are 
thrown  open  to  the  sick;  at  the  same  time,  refusal 
to  submit  to  examination  by  the  professor  or  students 
is  met  with  prompt  expulsion  of  the  obstreperous 
one.  Are  these  examinations  and  demonstrations, 
however,  a  matter  of  such  indifference  to  the  patient  *? 

Of  course,  every  effort  is  made  to  spare  his  or 
her  feelings.  But,  unfortunately,  it  is  not  always 
feasible  to  do  so;  certain  limits  have  to  be  passed: 
if,  for  instance,  the  patient  is  suffering  from  some 
rare  and  instructive  disease,  or  else  if  there  be  a 


EXAMINATION  AND  AUTOPSY       17 

dearth  of  clinical  material — which  is  frequently  the 
case,  not  only  in  small  university  towns,  but  even  in 
the  capitals.  This  is  what  we  learn  from  Professor 
Eichwald's  report,  read  at  a  conference  of  the 
Medico-Chirurgical  Academy  (of  St.  Petersburg) : 
"In  the  late  seventies  the  I.  Therapeutic  Section 
of  the  Clinical  Hospital  simultaneously  served  the 
students  of  the  III.  and  V.  courses,  and  also  the 
female  students,  for  the  purposes  of  practice,  which 
arrangement  was,  of  course,  a  great  hardship  upon 
the  patients.  The  latter  not  only  complained  of 
these  practical  studies  on  numerous  occasions,  as- 
cribing to  the  above  their  slow  recovery,  but  not 
infrequently  left  the  clinic  for  this  reason." 

In  general,  however,  one  must  confess  that  such 
cases  are  exceptional.  When  the  patient  is  subject 
to  examinations  for  the  purposes  of  study,  it  is  usual 
to  adhere  strictly  to  the  rule  that  the  latter  should 
have  no  detrimental  effect  upon  his  health.  But 
the  matter  does  not  only  lie  in  the  evasion  of  direct 
physical  harm  to  the  sufferer,  for  there  is  a  moral 
side  to  the  question.  A  semi-dark  ward  during  our 
evening  round,  seems  to  arise  before  my  eyes;  we 
students,  stethoscope  in  hand,  stand  around  the 
house-physician  who  demonstrates  amphorical  res- 
piration upon  one  of  the  patients.  The  latter,  a 
cotton-mill  hand,  is  in  the  last  stages  of  consump- 
tion. Terribly  wasted,  his  youthful  face  is  slightly 
cyanotic;  he  breathes  rapidly  and  superficially,  while 


i8     THE  MEMOIRS  OF  A  PHYSICIAN 

his  eyes  are  turned  to  the  ceiling  with  an  expression 
of  intense  inward  suffering. 

"If  you  will  apply  your  stethoscope  to  the 
patient's  chest,"  explains  the  house-physician,  "and 
at  the  same  time  strike  the  mallet  upon  the  plexi- 
meter  close  by,  you  will  hear  a  clear  metallic,  so 
called  'amphorical  resonance.'  .  .  .  Here,  col- 
league," he  continues,  turning  to  a  student,  and 
then,  addressing  the  patient,  "Sit  up"  .  .  .  and  so 
on. 

Serving  the  purposes  of  study  and  the  object  of 
coldly  impersonal  explanations,  such  lonesome  suf- 
fering stands  out  glaringly.  Even  if  it  strikes  no 
one  else,  the  sufferer  at  least  feels  the  incongruity 
acutely. 

All  examinations  unconnected  with  those  neces- 
sitated by  their  treatment,  have  a  particularly  de- 
pressing effect  on  the  bad  cases — at  the  same  time, 
from  an  instructional  point  of  view,  the  latter  present 
most  value.  The  intensity  of  this  aversion  for  such 
examinations  is  best  exemplified  by  the  fact  that 
even  those  with  the  slenderest  means  decline  to  go 
to  the  clinics;  although,  apart  from  the  described 
discomfort,  they  are  better  cared  for  in  every  re- 
spect in  these  infirmaries  than  would  be  possible 
elsewhere. 

In  1878  the  Medico-Chirurgical  Academy  nomi- 
nated a  commission  for  the  devising  of  some  means 
whereby  the  number  of  patients  in  its  hospital  might 


EXAMINATION  AND  AUTOPSY       19 

be  increased.  The  Commission,  among  other  meas- 
ures, recommended  adding  to  the  number  of  free 
beds. 

*'The  reserving  of  beds  for  paying  patients,"  it 
declared,  "is  inexpedient,  because  people  with  means 
do  not  go  to  the  clinics,  apprehensive  of  being  in- 
convenienced by  the  students'  examinations."  In 
1880  the  academical  authorities  again  petitioned  the 
government  for  powers  to  increase  the  number  of 
free  beds,  pointing  out  that  those  reserved  for  pay- 
ing patients  remained  unoccupied  almost  through- 
out the  year.^ 

Of  course  the  free  beds  will  never  be  vacant — 
all-powerful  Mother  Want  will  see  to  that.  ...  I 
not  infrequently  hear  it  said,  that  although  all  these 
examinations  and  practical  demonstrations  may  be 
distasteful  to  the  patient,  on  the  other  hand,  he 
enjoys  exemplary  nursing  gratis.  Quite  true:  but 
wealthy  people  enjoy  exemplary  nursing  without 
being  subject  to  all  this.  The  question  often  oc- 
curred to  me:  What  would  medical  science  do  if 
all  were  wealthy^  Probably  it  would  find  itself 
in  a  tight  place.  In  any  case,  even  now,  efforts  to 
shield  patients  from  these  examinations  with  an 
instructional  purpose,  have  been  made.  In  1893, 
for  instance,  the  working  classes  of  Berlin  boycotted 
the  Charite  hospital;  amongst  the  demands  formu- 

^  In  America  private  buildings  connected  with  general  hospitals 
where  the  patient  receives  the  utmost  privacy  are  greatly  in  de- 
mand. 


20    THE  MEMOIRS  OF  A  PHYSICIAN 

lated  by  those  who  joined  the  movement  was  the 
following:  "absolute  freedom  shall  be  given  the 
patients  in  acquiescing  or  declining  to  allow  of  their 
being  used  for  the  purposes  of  instruction."  If  the 
patients  enjoyed  such  liberty  everywhere,  many  and 
many  of  them  would  say :  "Leave  me  in  peace.  I 
understand  that  this  is  necessary  to  science,  but  I 
am  too  ill  to  take  science  into  consideration." 

The  patient  dies.  The  same  rules  which  demand 
«*  that  he  should  readily  submit  himself  to  be  examined 
by  the  students,  also  require  obligatory  autopsy  in 
the  case  of  the  bodies  of  those  who  die  in  the  Uni- 
versity hospitals. 

Every  morning  in  the  lobby  and  at  the  main 
entrance  of  each  clinic,  a  crowd  of  women  may  be 
noticed  for  hours  together,  on  the  lookout  for  the 
house-surgeon  or  physician.  When  he  passes,  they 
intercept  him  and  implore  that  the  remains  of  child, 
husband  or  parent  be  given  up  for  burial.  Some- 
times the  most  heart-rending  scenes  are  enacted. 
Naturally,  a  categorical  refusal  meets  all  such  re- 
quests. Having  failed  to  gain  her  point  from  the 
house-surgeon,  the  petitioner  goes  further,  impor- 
tunes all  those  in  authority,  finally  gets  at  the  pro- 
fessor and  supplicates  him  on  bended  knees  not  to 
have  the  deceased  dissected. 

"Why,  his  malady  was  a  well-known  one — oh, 
why  should  you  continue  to  worry  him  after  death?" 

Of  course,  here  again,  she  meets  with  the  same 


*<** 


EXAMINATION  AND  AUTOPSY       21 

refusal :  it  is  absolutely  necessary  to  perform  autopsy 
on  those  who  die;  without  that,  clinical  study  be- 
comes senseless.  But  to  the  mother,  the  autopsy 
of  her  child  is  no  less  terrible  than  its  death;  even 
educated  people  are  very  unwilling  to  give  their 
consent  to  a  post-mortem  examination  of  their  dear 
dead,  while  for  the  ignorant  poor  the  former  assumes 
the  shape  of  something  absolutely  horrible.  I  have 
seen  a  female  factor}^  hand  earning  40  kopecks  a 
day,  try  to  press  a  three-rouble  note  on  the  acting 
house-physician,  in  the  vain  hope  of  saving,  by  this 
bribe,  her  dead  child  from  "desecration."  Of 
course,  such  an  attitude  towards  autopsy  is  but  the 
result  of  prejudice,  but  notwithstanding  this  the 
grief  of  the  mother  remains  unaltered. 

Once,  during  the  summer,  I  was  present  at  the 
post-mortem  of  a  little  girl  who  had  died  of  croupous 
pneumonia.  Most  of  my  fellow-students  had  left 
for  the  vacation;  the  only  persons  present  were  the 
house-physician  on  duty  and  myself.  The  attend- 
ant, a  black-bearded  man  of  gigantic  stature,  opened 
the  body  and  took  out  the  internal  organs.  The 
dead  reposed  upon  the  table  with  head  thrown  back, 
her  blood-besmeared  abdominal  region  yawning 
open;  on  the  white  marble,  in  pools  of  blood,  lay  the 
removed  vitals.  The  house-physician  was  dissecting 
the  right  lung  with  a  knife,  on  a  small  wooden 
slab. 

''What  are  you  doing?"  suddenly  gasped  a  chok- 


22     THE  MEMOIRS  OF  A  PHYSICIAN 

ing  voice  from  the  threshold.  A  man  with  a  small 
red  beard,  dressed  in  a  pea-jacket,  with  a  deathly 
pale  face,  distorted  with  horror,  stood  in  the  door- 
way. It  was  the  little  girl's  father,  a  journey-man 
cobbler;  he  was  on  his  way  to  the  mortuary,  to 
enquire  when  the  deceased  might  be  laid  out,  and 
blundered  into  the  dissecting-room  instead. 

"What  are  you  doing  here,  you  brigands?"  he 
yelled,  shaking  all  over  and  staring  at  us  with  wide 
open  eyes.  The  knife  remained  paralysed  in  the 
anatomist's  hand. 

"Now  then,  what's  your  business  here?  Be  off!" 
said  the  attendant,  recovering  himself  and  approach-, 
ing  the  intruder. 

"So  this  is  where  you  cut  our  children  up,  is  it?" 
he  cried  with  a  kind  of  sobbing  howl,  stamping  his 
feet  and  shaking  his  clenched  iists;  "what  have  you 
done  to  my  little  girl?" 

He  made  a  run  towards  us.  The  attendant  seized 
him  under  the  armpits  from  behind  and  wrenched 
him  away ;  the  man  caught  hold  of  the  door-post  and 
yelled  for  help.  ... 

At  last  the  attendant  managed  to  push  him  into 
the  passage  and  locked  the  door  from  the  inside. 
The  cobbler  persisted  in  his  efforts  to  force  an  en- 
trance for  a  long  time,  crying  for  help  the  while, 
until  the  house-physician  lost  patience,  summoned 
the  porters  from  the  window  and  had  him  removed 
from  the  premises. 


EXAMINATION  AND  AUTOPSY       23 

If  another  child  of  that  man's  falls  sick,  he  will 
ruin  himself  in  nursing  it  at  home,  will  allow  it  to 
die  without  proper  aid,  but  will  never  consent  to 
take  it  to  the  clinic:  the  desecration  of  his  precious 
dead  were  too  high  a  price  to  pay  for  the  advantage 
of  hospital  nursing. 

By  the  way,  the  right  to  dissect  the  bodies  of 
patients  that  die  within  their  walls  has  not  only 
been  annexed  by  the  University  infirmaries,  but  by 
all  the  hospitals,  and  quite  illegally  too:  for  the  law 
gives  them  no  such  powers.  According  to  the  law, 
in  the  ordinary  hospitals  autopsy  is  obligatory  only 
when  required  for  the  purposes  of  judicial  investiga- 
tion; and  yet  I  don't  know  of  a  single  hospital 
where  the  deceased's  body,  in  accordance  with  his 
relatives'  wishes,  would  be  delivered  to  them  with- 
out autopsy  being  previously  performed.^  The 
relatives  of  such  patients  do  not,  however,  suspect 
that  the)^  have  the  right  to  demand  the  above. 

The  post-mortem  examination  of  each  patient  that 
succumbs  is  extremely  important  to  every  doctor, 
even  in  the  case  of  the  most  "common"  diseases: 
it  shows  him  his  mistakes  and  the  way  to  evade 
them  in  future,  accustoms  him  to  attentive  and  all- 
round  examination  of  his  patient,  enables  him  to 
obtain  a  clear  and  detailed  anatomical  presentment 

2  In  America  it  is  impossible  to  perform  an  autopsy  without  the 
consent  of  the  family  of  the  deceased.  But  in  some  hospitals  rela- 
tives are  required  to  sign  blank  forms  giving  permission  for  the 
autopsy  in  the  event  of  death. 


24    THE  MEMOIRS  OF  A  PHYSICIAN 

of  every  illness.  Without  autopsy  the  making  of  a 
good  physician  is  impossible,  without  it  medical 
science  cannot  advance  and  perfect  itself. 

It  is  absolutely  indispensable  that  all  should 
understand  this  as  clearly  as  possible  and  willingly 
consent  to  the  autopsy  of  their  relatives'  bodies. 
For  the  present,  the  public  mind  has  not  yet  grasped 
this  truth;  and  hospitals  attain  their  ends  by  dis- 
secting the  dead  in  opposition  to  the  wishes  of 
friends  and  relatives.  The  latter  humiliate  them- 
selves, go  down  on  their  knees  before  the  doctors, 
try  to  bribe  them — all  in  vain.  For  fear  of  a  post- 
mortem examination  in  the  event  of  death,  the 
friends  of  the  patient  do  all  they  can  to  prevent  his 
being  taken  to  the  hospital,  and  he  often  perishes  at 
home  through  lack  of  proper  attendance,  or  owing  to 
ignorant  nursing. 

At  the  hospital  in  which  I  subsequently  worked 
the  following  episode  had  taken  place:  there  was  a 
typhoid  patient,  a  little  boy  fivG  years  old;  symptoms 
of  perforated  intestine  appeared.  In  such  cases  ab- 
solute quiet  is  of  the  last  importance,  but  the  mother 
suddenly  made  known  her  wish  to  take  the  child 
home,  refusing  to  listen  to  all  remonstrances.  *'He's 
bound  to  die.  Better  that  he  should  die  at  home, 
for  then  he  won't  be  cut  up,"  she  said.  The  house- 
physician  was  compelled  to  give  the  woman  her 
way,  the  boy  succumbing  en  route.  .  .  .  This  case 
gave   rise   to  considerable   comment  amongst   the 


EXAMINATION  AND  AUTOPSY       25 

hospital-staff;  of  course,  the  profound  ignorance  and 
senseless  barbarity  of  the  Russian  lower-classes  was 
referred  to,  the  right  of  the  house-physician  to  per- 
mit the  boy's  removal  was  called  in  question,  as  well 
as  his  moral  and  judicial  responsibility  for  the  child's 
death.  But  the  main  interest  of  the  case  lies  else- 
where :  how  great  must  the  mother's  fear  of  autopsy 
have  been,  if  she  was  prepared  to  risk  her  offspring's 
life  to  escape  it !  The  house-physician  was  of  course 
neither  an  "ignoramus"  nor  a  "brute,"  but  that  the 
simplest,  and  one  would  think,  the  most  natural 
solution  of  the  problem,  never  entered  his  head,  is 
characteristic:  he  might  have  given  the  mother  a 
solemn  assurance  that  if  the  child  died  it  would  not 
be  dissected. 

But  those  who  have  to  suffer  most  from  the  neces- 
sity which  compels  us  to  study  medicine  on  the 
living,  are  the  women  who  lie  in  the  clinics.  My 
recollections  connected  with  this  phase  of  the  ques- 
tion are  especially  painful,  because  I  have  to  blush 
for  myself.  But  there  is  no  help  for  it,  as  I  have 
pledged  myself  to  write  all. 

A  young  woman  suffering  from  pleurisy  mounted 
the  professor's  dais  accompanied  by  the  two  students 
appointed  to  watch  her  case.  Having  read  her  "his- 
tory," one  of  the  students  stepped  up  and  touched 
the  shawl  which  enveloped  the  patient's  shoulders, 
thereby  intimating  that  she  was  to  undress.  The 
blood  mounted  to  my  face:  this  was  my  first  ex- 


26    THE  MEMOIRS  OF  A  PHYSICIAN 

perience  of  the  demonstration  of  a  young  female 
patient.  She  took  off  her  shawl  and  bodice  and 
lowered  her  chemise  as  far  as  her  waist;  her  face 
was  serene  and  proud. 

Then  commenced  the  usual  auscultations  and 
soundings.  I  sat  there,  hot  all  over,  trying  not  to 
look  at  the  patient;  I  felt  as  if  the  looks  of  all  my 
comrades  were  turned  my  way;  when  I  lifted  my 
eyes,  the  same  proud,  cold,  beautiful  face  bent  over 
her  pale  bosom,  met  them,  it  seemed  as  if  those 
strange  male  hands  were  not  feeling  her  body. 
When  we  rose,  my  glance  encountered  that  of  my 
neighbour,  a  fellow-student  and  almost  a  stranger  to 
me;  in  some  inexplicable  way  we  read  the  same 
thoughts  in  each  other's  eyes  and  exchanging  an 
angry  stare,  turned  aside  quickly. 

Was  there  any  voluptuous  feeling  in  me  when  the 
patient  stripped  beneath  my  eyes'?  There  was,  but 
very  little;  the  fear  of  such  a  feeling  predominated. 

But  later  on,  when  at  home,  the  recollection  of 
that  experience  acquired  a  delicately  voluptuous 
tint  and  I  reflected  with  a  secret  pleasure,  that  in 
the  future  I  should  often  be  the  witness  of  such 
scenes. 

And  of  course  there  were  many  similar  occur- 
rences. I  especially  well  remember  one  patient, 
Anna  Gratshoff  by  name,  a  young  girl  of  eighteen, 
of  rare  beauty.  She  had  heart  disease  with  a  very 
characteristic    prsesystolic    murmur;    the    professor 


EXAMINATION  AND  AUTOPSY       27 

advised  us  to  sound  her  frequently.  When  one  ap- 
proached, she  submissively  and  deftly  threw  off  her 
night-shift  and  sat  up  in  bed,  bared  to  the  waist, 
while  we  auscultated  her  in  turn.  I  tried  to  look 
upon  her  with  the  eyes  of  a  physician,  but  could  not 
help  observing  that  she  had  handsome  shoulders  and 
a  beautiful  breast,  and  the  fact  of  my  comrades 
taking  an  exaggerated  interest  in  the  prsesystolic 
murmur  did  not  escape  my  notice,  making  me  feel 
ashamed  that  this  should  be  so.  I  could  not  help 
suffering  on  behalf  of  the  girl,  the  more  so,  because 
I  was  conscious  of  the  impurity  of  our  glances. 
What  power  was  it  that  forced  her  to  strip  before 
us^  Would  not  all  this  have  a  lasting  and  deroga- 
tory effect  upon  her  in  future^ — I  conjectured,  try- 
ing to  read  upon  her  pretty,  almost  childish  face,  the 
whole  story  of  her  sojourn  in  our  clinic,  to  imagine 
her  indignation,  when  forced  to  appear  naked  before 
all  for  the  first  time,  and  how  she  had  resigned  her- 
self to  the  inevitable,  because  her  people  were  too 
poor  to  nurse  her  at  home,  and  how  she  got  used  to 
her  position  little  by  little.  .  .  . 

Once  during  an  out-patient  day  of  our  professor 
of  syphilology,  a  young  woman  came,  with  a  note 
from  her  doctor,  in  which  the  professor  was  begged 
to  determine  whether  the  rash  the  patient  had  was 
of  syphilitic  origin  or  not. 

"Let  us  see  the  rash!"  said  the  professor.  She 
showed  her  hand. 


.28    THE  MEMOIRS  OF  A  PHYSICIAN 

"Oh,  that's  nothing.  Healed  foruncuU,  Any- 
where else?" 

"On  the  chest,"  faltered  the  patient,  "but  it  isn't 
a  bit  different." 
"Let  us  see  it." 

"But  it  is  exactly  the  same  there,  nothing  to 
show,"  persisted  the  patient,  blushing. 

"Any  way,  please  show  us  your  rash :  we  are  very 
inquisitive!"  remarked  the  orofessor  with  a  humor- 
ous smile. 

After  demurring  considerably  the  patient  took  off 
her  bodice. 

"Oh,  that's  also  a  mere  trifle!  Anywhere  else*? 
Tell  your  doctor  that  there  is  nothing  serious  the 
matter." 

I  Meanwhile  the  assistant  had  drawn  down  the 
patient's  chemise  from  behind  and  examined  her 
back. 

"Serguei  Ivanovitch,  look  here!"  he  said  in  an 
undertone. 

P     The  professor  complied. 

■  "Ah  ...  a!  That  is  very  different!"  he  re- 
marked. "Undress  entirely — retire  behind  that 
screen.  .  .  .  Next!" 

The  patient  reluctantly  did  as  bidden.  The  pro- 
fessor examined  several  patients. 

"Ah,  yes!     And  the  other  patient,  has  she  un- 
dressed*?" he  asked  at  last, 
t.    The  assistant  went  behind  the  screen.    She  stood 


EXAMINATION  AND  AUTOPSY       29 

fully  attired  and  was  crying.  He  made  her  strip  to 
her  chemise.  Placing  the  patient  on  a  lounge  they 
began  to  examine  her;  she  was  examined  at  length 
in  a  detail  revolting  to  the  lay-person. 

"You  may  put  your  things  on!"  the  professor 
said  at  last,  and  turning  to  us,  while  drying  his 
hands  after  having  carefully  washed  them,  remarked : 
"It  is  difficult  to  say  anything  definite  for  the  pres- 
ent, gentlemen.  There,  my  dear,"  to  the  woman, 
"come  again  in  about  a  week." 

The  patient  was  already  dressed.  She  stood 
breathing  heavily,  gazing  motionlessly  at  the  floor 
with  unseeing,  wide-open  eyes. 

"No,  I  won't  I"  she  answered  in  a  trembling  voice 
and,  turning  on  her  heel,  rapidly  quitted  the  room. 

"What  was  the  matter  with  her,  I  wonder?"  asked 
the  professor  in  a  surprised  tone,  glancing  round. 

The  same  evening  a  young  lady-student  friend 
came  in  to  see  me.  I  described  the  scene  of  the 
morning. 

"Yes,  it's  very  hard!"  she  said,  "but  after  all, 
what's  to  be  done?  One  can't  learn  in  any  other 
way.  We  must  reconcile  ourselves  to  such  occur- 
rences." 

"Quite  true.  But  answer  me  this;  if  fou  had  to 
undergo  anything  of  the  kind— only  try  and  realise 
things  clearly — would  you  come  to  us?" 

She  was  silent  for  a  moment. 

"No,     I    wouldn't.  .  .  .  For    nothing    in    the 


30    THE  MEMOIRS  OF  A  PHYSICIAN 

world !"  she  smiled  apologetically — "I  would  rather 
die  I" — with  a  shiver. 

And  mark  you — she  deeply  venerated  science  and 
understood  thoroughly  that  "one  couldn't  learn  in 
any  other  way."  The  other  woman  understood 
nothing  of  such  questions;  all  she  knew  was  that 
she  had  not  the  means  to  pay  for  a  private  consulta- 
tion and  that  she  was  burdened  with  three  children. 

It  is  the  harsh  hand  of  necessity  which  drives  the 
poor  to  the  clinics,  to  the  profit  of  science  and  the 
medical  schools.  Unable  to  find  the  money,  they 
have  to  pay  for  their  treatment  with  their  bodies. 
.  .  .  But  for  many  the  price  is  too  high,  and  they 
prefer  to  die  unsuccoured.  This  is  what  the  cele- 
brated German  g)ni2ecologist  Hoffmeier  says: 
"Teaching  in  clinics  for  women  is  made  more  diffi- 
cult than  that  anywhere  else,  through  the  natural 
shame  of  women  and  their  perfectly  comprehensible 
aversion  to  demonstration  in  the  presence  of  students. 
According  to  my  experience,  I  think  that  in  small 
towns  it  would  hardly  be  possible  to  conduct  a 
gynaecological  clinic  if  all  patients,  without  excep- 
tion, were  not  chloroformed  for  the  purposes  of 
examination.  At  the  same  time,  examinations  con- 
ducted by  an  inexperienced  hand  are  often  exceed- 
ingly painful,  and  examination  by  a  large  number 
of  students  is  unpleasant  in  the  highest  degree.  For 
this  reason,  in  most  clinics  for  women,  the  patients 
are  demonstrated  and  examined  under  an  anaesthetic. 


EXAMINATION  AND  AUTOPSY       31 

"Least  feasible  of  all  is  the  teaching  of  practical 
gynaecological  out-patients  relief  work,  at  any  rate 
in  small  towns.  He  who  desires  to  obtain  real 
knowledge  in  this  branch,  must  personally  examine 
the  patients.  And  this  is  what  the  latter  dislike 
most.  The  fear  of  such  examinations  in  the  pres- 
ence of  students — especially  by  the  students  them- 
selves — in  our  country  at  any  rate — often  proves 
more  "powerful  than  the  Patients'  dressing  need  for 
helpr ' 

In  the  abstract  such  niceness  may  appear  foolish; 
the  students  are  practically  doctors — and  bashful- 
ness  in  the  presence  of  one's  medical  adviser  is  out 
of  place.  But  the  whole  aspect  of  the  case  changes 
when  you  put  yourself  in  the  patient's  position. 
We  men  are  naturally  less  modest  than  women, 
nevertheless  I  can  vouch  for  myself  that  I  would 
never  consent  to  be  led  out  perfectly  naked  beneath 
the  eyes  of  a  hundred  women,  or  tolerate  these 
women  to  feel  me  all  over,  examine  me  minutely, 
question  me  about  everything^  stopping  at  nothing. 
Thus,  I  came  to  see  that  although  this  niceness  may 
be  unreasonable,  nevertheless  it  ought  to  be  taken 
very  much  into  consideration.  Still,  the  axiom  re- 
mains— "it  is  impossible  to  study  in  any  other  way." 
In  the  Middle  Ages  medical  study  went  no  further 
than  theoretical  lectures,  in  which  the  works  of  the 
Arabian  and  ancient  physicians  were  commented 
upon;  for  the  practical  schooling  of  the  students  did 


32    THE  MEMOIRS  OF  A  PHYSICIAN 

not  enter  into  the  programme  of  the  universities  of 
those  days.  According  to  Pirogoff,^  as  recently  as 
the  late  "forties,"  in  some  of  the  out-of-the-way 
German  universities  "bleeding  was  taught  on  pieces 
of  soap,  and  amputation  on  turnips."  Fortunately 
for  medicine  and  the  sick,  those  times  have  vanished 
forever,  and  to  sigh  for  them  were  criminal,  be- 
cause nowhere  can  the  lack  of  practical  preparation 
work  so  much  harm  as  in  the  physician's  art.  And 
practical  preparation  is,  I  repeat,  impossible,  with- 
out the  accompaniment  of  all  that  has  just  been 
described. 

There  we  stumble  against  one  of  those  contra- 
dictions which  we  are  destined  to  encounter  so  often 
as  we  proceed:  we,  the  representatives  of  the  most 
humane  of  the  sciences,  are  compelled  to  trample  the 
most  elementary  humanity  under  foot.  Availing 
itself  of  the  inability  of  the  poor  to  pay  for  medical 
aid,  our  school  takes  advantage  of  their  need  and 
converts  the  sick  into  dummies  to  be  used  for  the 
purpose  of  study,  ruthlessly  setting  at  nought 
woman's  shame,  adding  to  the  sorrow  of  the  be- 
reaved mother  by  "desecrating"  her  dead  child,  etc. 
But  there  is  no  middle  course:  no  patient  would 
ever  consent  to  serve  the  cause  of  science  of  his  own 
free  will ! 

I  am  quite  at  a  loss  to  suggest  any  practicable 

8  PirogoflF  was  one  of  Russia's  most  celebrated  surgeons. — Trans- 
lator. 


EXAMINATION  AND  AUTOPSY       33 

way  out  of  this  dilemma;  all  I  know  is,  that  we 
cannot  do  without  medicine,  and  that  no  other  way 
of  acquiring  knowledge  is  possible.  At  the  same 
time  I  must  confess  that  if  want  were  to  force  my 
wife,  or  sister,  into  the  position  of  the  unhappy 
patient  who  consulted  the  professor  of  syphilolog}% 
I  would  cry  out  that  I  did  not  care  a  fig  for  all  the 
schools  of  medicine  in  the  world  and  that  no  one 
was  given  the  right  to  degrade  the  feelings  of  his 
fellow-creatures,  merely  because  they  chanced  to 
be  poor. 


CHAPTER  III 

WHAT    MEDICINE    HAS   NOT   ACCOMPLISHED  AND 
WHAT    IT    HAS 

DURING  my  third  year,  about  a  fortnight  after 
the  term  had  begun,  I  was  present  for  the  first 
time  at  an  autopsy.     The  body  of  a  woman  of 
forty,  wasted  to  a  skeleton,  lay  on  a  marble  table. 
The  professor  of  pathological  anatomy,  a  leathern 
apron  tied  round  him,  was  drawing  on  a  pair  of 
rubber  gloves,  cracking  jokes  the  while;  at  his  side 
stood  one  of  his  colleagues — a  surgeon,  in  whose 
clinic  the  woman  had  died — dressed  in  a  white  gown. 
The  benches  encircling  the  dissecting  table  in  the 
amphitheatre  were  crowded  with  students. 
I     It  was  obvious  that  the  surgeon  was  not  at  his 
ease;  he  pulled  at  his  moustache  nervously  and  his 
eyes  roamed  over  the  serried  ranks  of  students  with 
an  assumed  expression  of  boredom;  when  the  pro- 
fessor of  pathology  made  a  joke,  he  hastened  to 
smile  pleasantly;  altogether  his  manner  towards  the 
pathologist  was  that  of  a  school-boy  before  his  ex- 
aminer; he  seemed  anxious  to  ingratiate  himself  with 
the  other.     As  I  gazed  upon  him,  it  struck  me  as 
strange  that  this  should  be  the  same  awe-inspiring 

34 


MEDICINE'S  ACHIEVEMENT         35 

N — — ,  who  comported  himself  with  such  Olympian 
majesty  in  his  clinic. 

"So  she  died  of  peritonitis'?"  shortly  inquired  the 
professor  of  pathology. 

"Yes." 

"Was  she  operated  upon'?" 

"Yes,  she  was." 

"Humph!"  grunted  the  pathologist,  slightly  lift- 
ing his  brows,  and  commenced  the  autopsy.  The 
prosector  made  a  long  incision  in  the  skin  from  the 
chin  to  the  symphisis  pubis.  The  pathologist  care- 
fully opened  the  abdominal  cavity  and  began  to 
examine  the  inflamed  peritoneum  and  the  glued 
intestines.  In  his  clinic,  the  day  before,  the  surgeon 
had  expressed  to  us  his  opinion  as  to  the  cause  of 
the  patient's  death:  the  tumour  which  he  had  in- 
tended to  remove  was  found  to  adhere  extensively 
to  the  intestines;  probably,  while  disengaging  these 
adhesions,  the  intestine  sustained  a  slight  injury, 
which  resulted  in  purulent  inflammation  of  the  peri- 
toneum. This  supposition  was  confirmed  by  the 
post-mortem  examination.  The  pathologist  sought 
out  the  wounded  part  and  removed  a  section  of  the 
intestine  with  a  small  abrasion:  this  he  handed  the 
students  on  a  plate,  for  examination.  While  we 
scrutinised  the  sinister  little  wound,  surrounded  by 
a  film  of  pus,  curiously,  the  surgeon  frowned  and 
worried  his  moustache.  I  followed  his  movements 
with  concentrated  and  malicious  attention :  here  was 


36    THE  MEMOIRS  OF  A  PHYSICIAN 

the  tribunal  before  which  all  their  sins  and  mistakes 
were  mercilessly  exposed  and  punished!  That 
woman  applied  to  him  for  aid  and,  thanks  to  his 
intervention,  she  now  lay  before  us  a  corpse;  it  were 
interesting  to  learn  whether  her  relatives  knew  this, 
whether  the  operator  had  seen  fit  to  explain  the 
cause  of  her  death  to  them? 

The  autopsy  was  at  an  end.  In  his  description 
of  the  case  the  pathologist  declared  that  peritonitis 
had  undoubtedly  been  caused  by  the  wounding  of 
the  intestine,  but  owing  to  the  mass  of  adhesions 
and  ligatures  of  the  growth,  it  was  extremely  diffi- 
cult to  notice  the  scratch,  and  that  in  such  compli- 
cated operations  the  best  surgeons  could  not  be 
guaranteed  against  untoward  accidents. 

The  two  professors  then  warmly  shook  hands  and 
departed,  the  students  crowding  out  of  the  building 
in  their  wake. 

That  first  experience  of  a  post-mortem  examina- 
tion left  a  strange  and  painful  impression  behind  it. 
* 'Peritonitis  was  caused  by  a  wound  to  the  intestine; 
it  is  difficult  to  notice  such  an  abrasion ;  unfortunate 
accidents  happen  to  the  best  surgeons.''  How  very 
simple  it  all  sounded!  One  might  be  led  to  think 
that  the  whole  question  concerned  an  experiment  in 
chemistry  which  had  fallen  flat,  its  mere  want  of 
success  being  the  most  important  consideration. 
The  reasons  for  the  miscarriage  were  stated  with 
complete  sang  froid^  the  person  responsible,  even  if 


MEDICINE'S  ACHIEVEMENT  37 

he  were  agitated,  experiencing  uneasiness  merely  be- 
cause his  amour  propre  was  at  stake.  ...  In  real- 
ity, however,  it  was  a  matter  which  concerned  the 
destruction  of  a  human  life,  no  more  nor  less,  a  mat- 
ter which  involved  something  incomparably  more 
terrible  in  its  import.  And  the  inevitable  question 
arose:  how  dared  such  an  operator  continue  to  pur- 
sue his  vocation?  A  physician  whose  duty  it  is  to 
heal,  kills  his  patient !  Such  a  crying  contradiction 
was  inadmissible  and  at  the  same  time  it  seemed  to 
pass  unnoticed. 

I  felt  as  if  I  had  suddenly  found  myself  in  a 
school  of  augurs. 

We  students  were  future  augurs — no  need  to  be 
squeamish  in  our  presence — and  therefore  we  were 
introduced,  without  more  ado,  to  the  seamy  side  of 
our  business.  The  lay  mind  might  rebel  at  the 
existence  of  such  a  reverse  to  the  medal;  we,  how- 
ever, had  to  accustom  ourselves  to  view  matters  in 
a  "broader"  light.  .  .  . 

The  further  I  penetrated  into  medicine,  the  more 
that  impression  of  my  first  autopsy  grew  upon  me. 
In  the  clinics,  at  the  theoretical  lectures  at  the  post- 
mortems, in  the  text-books — it  was  the  same  every- 
where. Side  by  side  with  that  brilliant  medicine 
of  the  foot-boards,  which  heals  and  resurrects,  and 
for  the  sake  of  which  I  had  taken  up  its  study, 
another  medicine  slowly  revealed  itself  to  me — a 
helpless,  impotent,  erring  and  false  science,  which 


38     THE  MEMOIRS  OF  A  PHYSICIAN 

undertook  the  treatment  of  diseases  which  it  could 
not  identify,  painstakingly  diagnosed  illnesses  which 
it  could  not  cure. 

In  the  text-books  I  often  came  across  descriptions 
of  diseases  winding  up  with  the  following  remark: 
"The  diagnosis  of  this  disease  is  only  possible  on  the 
dissecting  table" — as  if  such  timely  enlightenment 
could  do  any  one  any  good !  Perhaps  a  child  with 
tubercular  pyo-pneumothorax  would  be  shown  us; 
emaciated  and  shrunken,  with  protruding  bones  and 
a  bluish  face,  it  would  sit  there  breathing  rapidly. 
When  laid  upon  its  back  it  would  commence  to 
cough  as  if  about  to  render  up  its  soul.  The  pro- 
fessor with  serious  mien,  as  if  performing  an  act  of 
the  greatest  importance,  would  localise  the  region 
of  condensation,  determine  the  extent  of  the  trans- 
position of  the  mediastinum,  etc.,  while  I  followed 
his  movements,  sneering  covertly  to  see  all  the  trou- 
ble he  took  over  his  examinations,  only  to  state  in 
the  end,  that  the  patient's  case  was  hopeless  and 
that  we  were  powerless  to  cure  him.  What  sense 
was  there  in  his  diagnosis?  Never  mind  how  subtle 
the  latter  might  be,  after  all  it  was  but  equivalent 
to  Moliere's  pithy  words,  "They  will  tell  you  in 
Latin  that  your  daughter  is  ill"  ("L^  medecin  tnal- 
gre  lui'').  All  this  is  pitiful  and  ludicrous.  I 
recalled  Mephistopheles'  definition  of  the  spirit  of 
medicine ; — • 


MEDICINE'S  ACHIEVEMENT  39 

Der  Geist  der  Medicin  ist  leicht  zu  fassen : 
Ihr  durchstudiert  die  gross  und  kleine  Welt, 
Um  es  am  Ende  geh'n  zu  lassen 
Wie's  Gott  gefallt.^ 

In  the  treatment  of.  diseases  I  was  always  struck 
by  the  extreme  instability  and  indefinite  character 
of  their  symptoms,  the  large  number  of  remedies 
offered  against  every  ill — and,  at  the  same  time,  at 
the    utter   uncertainty   of   their   efficacy.     Let   me 
quote  an  extract  from  Strumpell's  well-known  text- 
book:    "Up    to    the    present    the    treatment    of 
aneurism  of  the  aorta  gives  very  doubtful  results; 
nevertheless,  in  every  case,  we  have  the  right  to  try 
the  effect  of  either  one  or  the  other  of  the  remedies 
recommended."  .  .  .  "To  prevent  recurring  fits  of 
angina    pectoris^'''    we    find    in    the    same    work: 
"Many   remedies    are    recommended:    arsenic,    sul- 
phate of  zinc,  nitrate  of  silver,  bromide  potassium, 
quinine,  etc.     No  harm  can  be  done  if  we  try  any 
one  of  these  remedies,  but  one  should  not  promise 
oneself  any  sure  success."     And  so  on  ad  infinitum. 
"One  may  try  this  or  that.  ...  No  harm  can  be 
done  by  essaying  this.  .  .  .  Some  have  greatly  ap- 
proved of  the  following.  ...  To  give  so-and-so  a 
trial  were  not  a  bad  idea."  ...  I  came  to  the  uni- 

1  It  is  easy  to  grasp  the  spirit  of  medicine: 
You  carefully  study  the  great  and  lesser  world 
To  allow  things  in  the  end  to  take  the  course 
It  pleaseth  God, 


40    THE  MEMOIRS  OF  A  PHYSICIAN 

versity  to  be  taught  how  to  cure  the  sick,  and  I  was 
asked  to  "try"  this  or  that  drug;  and,  mark  you, 
without  any  guarantee  of  success ! 

Not  a  day  passed  without  my  learning  some  new 
facts  which  still  further  undermined  my  respect  for, 
and  faith  in  medicine.  Pharmacology  introduced 
us  to  a  whole  series  of  remedies,  known  to  he  utterly 
ineffective,  and  nevertheless  recommended  their  use. 
If  the  nature  of  the  patient's  disease  is  not  as  yet 
clear  to  me  I  must  await  further  developments  be- 
fore being  enabled  to  diagnose  it  definitely.  Or 
else,  if  it  be  incurable,  I  am  told  that  "one  cannot 
allow  the  patient  to  go  without  medicines."  In 
such  cases  it  is  customary  to  prescribe  neutral  reme- 
dies ;  there  is  a  special  term  for  the  latter :  ut  aliquid 
-fiat  (an  abbreviation  for  ut  aliquid  videatur). 
This  trick  is  practised  so  as  to  make  the  patient 
think  that  something  is  being  done  for  him. 

Our  professor  would  enlarge  upon  such  matters 
in  the  most  serious  and  unemotional  manner.  I 
looked  him  in  the  face  with  internal  laughter  and 
thought:  "Now  really,  aren't  you  an  augur? 
Wouldn't  we  laugh  like  augurs,  if  we  could  see  our 
patient  anxiously  glancing  at  the  clock,  afraid  to 
be  ten  minutes  late  with  his  weak  mixture  of  acidu- 
lated syrup?" 

Soon  the  existence  in  medicine  of  a  fairly  large 
assortment  of  very  instructive  so-called  "special 
terms"   became  known  to  me.     "To  diagnose  ex 


MEDICINE'S  ACHIEVEMENT         41 

juvantihus^  according  to  what  can  help,"  for  in- 
stance! You  prescribe  a  certain  course  of  treat- 
ment, and  if  the  above  proves  efficacious,  you 
conclude  that  the  patient  is  suffering  from  such  and 
such  a  disease;  thus  the  second  step  is  taken  before 
the  first  has  been  made,  and  the  whole  science  of 
medicine  turned  upside  down;  the  patient's  illness 
being  unknown,  he  is  treated  in  a  given  way,  so  as 
to  ascertain  according  to  the  result  obtained,  whether 
he  ought  to  have  been  thus  treated. 

I  became  more  and  more  impregnated  with  a 
species  of  absolute  medical  nihilism,  that  nihilism 
which  is  so  characteristic  of  all  ''half-knowers."  It 
seemed  to  me  that  I  had  now  penetrated  to  the  core 
of  medicine,  having  at  least  grasped  the  fact  that  it 
possessed  but  two  or  three  efficacious  remedies,  the 
rest  being  ut  aliquid  fiat;  that  with  its  pitiful  and 
imperfect  means  of  diagnosis,  it  blundered  in  the 
dark,  pretending  to  wisdom.  When  talking  on  the 
subject  with  the  laity,  I  smiled  knowingly  and  said 
that  to  confess  frankly,  "all  our  doctoring  was 
merely  humbug." 

The  question  arises  as  to  why  the  foregoing 
should  have  been  instrumental  in  my  arriving  at 
such  sweeping  and  final  conclusions'?  I  think  that 
the  foundation  for  such  an  opinion  was  based  upon 
the  following  popular  foible,  which  I  also  uncon- 
sciously shared:     "You  are  a  physician,  therefore 

1  In  America  termed  "The  Therapeutic  Test." 


42     THE  MEMOIRS  OF  A  PHYSICIAN 

you  ought  to  be  able  to  recognise  and  cure  every 
ill;  if,  however,  you  are  powerless  to  do  so,  it  fol- 
lows that  you  must  be  a  quack." 

Because  medicine  could  not  accomplish  all^  I  held 
it  up  to  derision,  shutting  my  eyes  to  its  positive 
achievements  and  declining  to  take  into  considera- 
tion the  actual  means  at  our  science's  disposal  and 
their  limitations.  The  attitude  of  the  great  un- 
thinking majority  towards  medicine  is  identical 
with  the  above.  ...  In  1893,  a  "cardiac  polypus 
discovered  by  chance  at  a  post-mortem  examina- 
tion," was  displayed  among  the  pathologico-ana- 
tomical  specimens  on  show  at  the  Hygienic 
Exhibition  held  in  St.  Petersburg.  That  polypus 
greatly  amused  a  writer  in  a  certain  important 
newspaper  of  the  metropolis:  "See  how  clever  our 
doctors  are!  An  edifying  sort  of  a  'chance'  find!" 
Such  was  his  theme.  The  same  Hygienic  Exhibi- 
tion which  furnished  such  rich  proof  of  what  medi- 
cine could  do,  was  non-existent  to  the  writer  of  the 
"leaderette" ;  of  all  the  wealth  of  material  it  offered, 
he  only  had  eyes  for  that  solitary  polypus,  and  ac- 
cordingly indiscriminately  loaded  both  doctors  and 
medicine  with  his  ridicule  and  contempt,  without 
caring  to  find  out  whether  it  were  possible  to  locate 
such  a  growth  during  life.  Nothing  should  be  im- 
possible to  the  physician;  this  is  the  standpoint  held 
by  the  masses.  And  at  that  period  I  judged  in  the 
same  way. 


MEDICINE'S  ACHIEVEMENT  43 

But  a  certain  episode  wrought  a  complete  change 
in  me.  A  woman  of  about  fifty  was  admitted  to 
our  clinic.  She  had  a  large  swelling  on  the  left 
side  of  the  abdomen.  I  was  appointed  to  watch  her 
case.  It  devolved  upon  me  to  examine  the  patient, 
define  her  illness  and  record  its  course;  when  the 
patient  was  demonstrated  before  the  students,  it 
was  my  duty  to  give  the  history  of  her  complaint, 
acquaint  my  audience  with  the  results  of  my  exami- 
nations and  state  my  diagnosis.  After  this  the  pro- 
fessor would  point  out  my  mistakes  and  omissions, 
himself  minutely  examine  the  patient  and  finally 
make  known  his  own  opinion. 

My  patient's  swelling  occupied  the  entire  left 
half  of  her  ventral  regions  from  the  hypochondrium 
to  the  osiliacum.  What  was  the  nature  of  the 
swelling"?  From  which  of  her  organs  did  it  origi- 
nated Neither  my  questionings  nor  my  examina- 
tions availed  to  furnish  me  with  any  more  or  less 
approximate  indications;  it  was  just  as  easy  to  sus- 
pect cystic  tumour  of  the  ovarium,  echinococcus  of 
the  spleen,  hydronephrosis  or  cancer  of  the  pancreas. 
I  ransacked  every  text-book  I  could  lay  hands  on, 
and  this  is  what  I  found  in  them : — 

"It  is  very  easy  to  confound  echinococcus  of  the 
kidneys  with  hydronephrosis;  we  have  also  fre- 
quently discovered  soft  sarcomatous  tumours  of  the 
kidneys  when  we  had  been  sure  that  we  were  dealing 
.with  hydronephrosis"  (Tillman's  Special  Surgery), 


44    THE  MEMOIRS  OF  A  PHYSICIAN 

"Cancer  of  the  kidneys  is  often  mistaken  for 
retroperitoneal  tumours;  tumour  of  the  ovarium  or 
of  the  spleen,  for  large  abscesses  in  the  pelvic  region, 
etc."  (Strumpell). 

''In  cases  of  cystoma  of  the  ovarium  ^  very  un- 
pleasant mistakes  in  diagnosis  are  made.  The 
distinguishing  of  cystic  tumour  of  the  ovarium,  as 
differentiated  from  hydronephrosis,  is  one  of  the 
most  dangerous  of  rocks;  because,  if  hydronephrosis 
be  extensive,  superficial  examination  furnishes  an 
identical  picture  with  the  first  named  affection; 
thanks  to  this,  such  diagnostical  mistakes  are  far 
from  rare"  (Schroeder's  GyncBCology), 

"The  clinical  symptoms  of  cancer  of  the  pancreas 
are  rarely  sufficiently  clear  for  a  true  diagnosis" 
(Strumpell). 

In  a  frame  of  mind  both  sceptical  and  hostile 
towards  medicine,  a  contemptuous  sneer  curling  my 
lip,  I  perused  these  confessions  of  impotence  and 
incompetence.  It  seemed  almost  as  if  I  were 
pleased  at  being  unable  to  make  head  or  tail  of  my 
case;  for  was  I  to  blame  because  our  "science"  (save 
the  mark  I)  proved  powerless  to  furnish  me  with 
anything  approaching  a  reliable  clue  to  the  truth? 
The  statement  of  the  bare  fact  that  my  patient  had 
a  swelling  in  the  abdominal  region  was  the  only  one 
I  could  conscientiously  make.  The  role  of  a  char- 
latan being  distasteful,  I  refused  to  choose  at  ran- 

1  Cystoma  ovarii  or  cystoma  of  x^%  Qvary. 


MEDICINE'S  ACHIEVEMENT         45 

• 

dom  and  boldly  declare  in  favour  of  hydronephrosis, 
knowing  full  well  that  sarcoma,  echinococcus  or 
anything  else,  were  just  as  likely. 

The  day  for  the  demonstration  of  my  patient 
arrived.  She  was  brought  into  the  lecturing-room 
on  a  stretcher  and  I  was  called  to  her  side.  I  read 
her  "anamnesis"  and  described  the  results  of  my 
examinations. 

"And  what  is  your  diagnosis'?"  asked  the  pro- 
fessor. 

"I  don't  know,"  I  answered  sulkily. 

"Well,  approximately?" 

I  silently  shrugged  my  shoulders. 

"I  certainly  agree  that  the  case  is  by  no  means  a 
simple  one,"  said  the  professor,  and  proceeded  to 
interrogate  the  patient  himself. 

He  began  by  allowing  her  to  give  her  own  ac- 
count of  her  illness.  I  based  all  my  subsequent 
investigations  upon  it;  the  professor,  on  the  other 
hand,  took  her  recital  into  consideration  very  little. 
When  she  had  done,  he  began  to  question  her  very 
carefully  and  minutely  on  the  state  of  her  health 
prior  to  her  present  malady;  upon  its  commence- 
ment, asked  her  all  about  her  functions  during  her 
sickness.  Thanks  to  this  skilful  catechism  alone, 
things  assumed  quite  a  new  aspect;  instead  of  a 
chaotic  array  of  symptoms,  a  complete  presentment 
of  the  diseased  organism's  life  unfolded  itself  before 
us,  in  all  its  deflections  from  the  normal.     Next, 


46    THE  MEMOIRS  OF  A  PHYSICIAN 

the  professor  examined  the  patient's  swelling,  lay- 
ing great  stress  upon  its  consistency,  noted  whether 
it  was  displaced  by  respiration  or  had  any  connec- 
tion with  the  womb,  determined  its  position  in  rela- 
tion to  the  colon,  etc.  And  at  last  the  professor 
began  his  deductions.  He  approached  them  slowly 
and  warily,  as  a  blind  man  groping  his  way  along 
the  edge  of  a  precipice ;  he  did  not  leave  the  smallest 
symptoms  without  attentive  and  searching  consid- 
eration; to  explain  the  most  insignificant  symptom, 
which  I  never  would  have  noticed,  he  turned  the 
whole  tremendous  arsenal  of  anatomy,  physiology 
and  pathology  upside  down;  he  himself  met  every 
contradiction  and  obscure  point  half  way,  and  passed 
on  only  after  completely  clearing  the  matter  up. 
.  .  .  And  when,  finally,  he  arrived  at  his  diagnosis 
of  "soft  cancer  of  the  left  kidney"  after  having 
sifted  all  the  evidence,  his  verdict  was  obviously  the 
logical  outcome  of  the  foregoing. 

I  listened  dumfounded  and  enraptured:  how 
petty  and  childish  my  own  investigations  and  all  my 
scepticism  appeared  to  me  now!  The  tangled  and 
obscure  tableau^  which  it  seemed  to  me  impossible 
to  unravel,  had  become  crystal-clear  and  perfectly 
comprehensible — and  this  was  merely  due  to  the 
professor  not  having  deemed  any  trifle  unworthy  of 
attention. 

A  week  later  the  patient  died.  Again,  as  of 
yore,  the  corpse  lay  upon  the  dissecting  table,  once 


MEDICINE'S  ACHIEVEMENT  47 

more  the  students  crowded  around  the  same  pro- 
fessors, following  the  autopsy  with  strained  atten- 
tion. The  pathologist  extracted  from  the  abdomen 
of  the  deceased  a  tumour  the  size  of  a  human  head, 
and  after  careful  examination  pronounced  it  to  be 
medullary  cancer  (soft  cancer)  of  the  left  kidney. 

I  can  hardly  describe  the  feeling  of  enthusiastic 
pride  in  science  which  welled  up  within  me  on 
hearing  those  words.  While  looking  at  the  soft 
crimson  mass,  that  lay  upon  a  wooden  dish,  I  sud- 
denly called  to  mind  our  country  bailiff,  Vlass — 
a  fiery  hater  of  medicine  and  doctors.  "How  are 
the  doctors  to  know  what  goes  on  inside  me^  Can 
they  see  through  one"?"  he  used  to  ask  with  a  scorn- 
ful snort.  Yes,  it  was  just  a  case  of  "seeing 
through  one."  .  .  . 

From  that  day  forward,  my  attitude  towards 
medicine  underwent  a  radical  change.  On  com- 
mencing its  study  I  expected  it  to  accomplish  every- 
thing;  seeing  that  medicine  could  not  do  all,  I  con- 
cluded that  it  could  do  nothing.  Now,  however, 
I  saw  how  much  it  could  still  do,  and  that  ''much'" 
filled  me  with  reliance  in,  and  respect  for,  that 
science  I  had  so  recently  despised  from  the  bottom 
of  my  soul. 

A  patient  lies  before  me;  he  is  feverish  and  com- 
plains of  pains  in  the  side;  on  auscultation  the 
deadened  sound  shows  that  in  one  part  of  the  thorax 
the  air  contained  by  the  lungs  has  given  place  to 


48     THE  MEMOIRS  OF  A  PHYSICIAN 

morbid  secretion;  but  the  question  arises  whether 
it  is  located  in  the  lung  proper  or  the  pleural  space. 
I  place  my  hand  on  the  patient's  chest  and  make 
him  loudly  say  "ninety-nine."  The  vibration  of 
the  thorax  on  the  affected  side  is  weakened,  this 
circumstance  telling  me  as  plainly  as  if  I  could  see 
all  with  my  own  eyes  that  the  secretion  is  located  in 
the  pleural  sac — not  in  the  lung.  Another  patient 
has  paralysis  of  the  left  leg;  I  strike  the  sinews  of 
the  knee  with  my  mallet — ^his  leg  leaps  up  violently ; 
this  shows  that  the  affection  does  not  lie  in  the 
peripheral  nerves,  but  somewhere  above  their  start- 
ing-point in  the  spinal  marrow;  but  where?  I  care- 
fully ascertain  whether  the  skin  has  retained  its 
sensitiveness,  whether  the  other  limbs  are  affected, 
whether  the  functions  of  the  cerebral  nerves  are 
in  order,  etc. — and  can  at  last  say  with  complete 
certainty  that  the  affection  which  has  called  forth 
paralysis  of  the  left  leg  is  located  in  the  cortex  of 
the  central  convolution  of  the  right  cerebral  hemi- 
sphere, near  the  sinciput.  What  stupendous  pre- 
paratory work  of  centuries  was  necessary  to  evolve 
such  seemingly  simple  methods  of  examination ;  how 
much  power  of  observation,  genius,  laborious  re- 
search and  knowledge  must  have  been  expended! 
Truly  the  conquests  of  science  are  vast  I 
By  sounding  a  diseased  heart  it  is  possible  to  tell 
which  of  the  four  valves  is  defective  in  its  action, 
and  determine  the  cause  thereof;  by  employing  cor- 


MEDICINE'S  ACHIEVEMENT         49 

responding  mirrors,  we  are  able  to  examine  the 
inside  of  the  eye,  the  nose  and  gullet,  the  larynx, 
vagina,  even  the  bladder  and  stomach.  Invisible, 
mysterious  and  obscure  "infection"  has  been  ex- 
plained; we  can  now  cultivate  it  in  test-tubes,  in 
its  pure  form,  and  investigate  its  properties  beneath 
the  microscope. 

In  midwifery  the  whole  complicated  mechanism 
of  child-birth  has  been  studied  with  almost  mathe- 
matical precision,  and  no  matter  what  the  child's 
position,  we  know  exactly  which  artificial  manipula- 
tions ought  to  be  recoursed  to  for  assisting  the  nat- 
ural process  of  delivery.  .  .  .  We  cauterise  the 
nasal  conchils  of  a  child  with  white-hot  metal,  after 
having  made  them  insensible  to  pain  through  the 
agency  of  cocaine:  the  living  flesh  hisses  and 
crackles,  a  smell  of  burned  meat  is  wafted  through 
the  air,  while  the  child  sits  still  smiling,  contentedly 
puffing  the  smoke  from  its  nostrils. 

But  it  is  impossible  to  enumerate  all.  Of  course, 
much,  very  much  still  remains  to  be  done,  but  this 
is  merely  a  question  of  time.  We  cannot  guess 
how  far  science  may  go.  Why,  a  few  years  past  the 
very  idea  of  actually  seeing  through  the  human  body 
would  have  struck  one  as  an  absurdity;  now,  how- 
ever, thanks  to  Roentgen,  that  absurdity  has  crys- 
tallised into  fact.  Forty  years  ago  ^  three-fourths 
of  those  operated  upon  died  of  septic  infection: 

2  This  is  a  conservative  estimate. 


50     THE  MEMOIRS  OF  A  PHYSICIAN 

pysemia  was  the  curse  of  surgery,  against  which  the 
skill  of  the  operator  was  helpless.  "I  positively  do 
not  know  what  to  say  of  that  terrible  curse  of 
surgical  practice,"  wrote  Pirogoif,  in  1854,  despair- 
ingly; "all  is  enigmatic  about  it:  its  origin  and  de- 
velopment. So  far,  it  is  as  incurable  as  cancer." 
"When  looking  back  upon  the  cemeteries,"  he  writes 
elsewhere,  "where  lie  buried  all  those  who  have  been 
infected  in  the  hospitals,  I  do  not  know  what  to 
wonder  at  more:  the  stoicism  of  the  surgeons,  who 
continue  to  devise  new  operations,  or  the  confidence 
which  hospitals  continue  to  enjoy  amongst  the 
public."  Then  Lister  appeared  upon  the  scene,  in- 
troducing antiseptic  treatment;  this  gave  place  to 
the  still  more  perfect  aseptic  method  and  the  sur- 
geon, ceasing  to  be  the  slave  of  septic  infection,  be- 
came its  master;  nowadays  if  a  patient  dies  of  it 
after  an  operation,  the  operator  is  to  blame,  not 
science. 

If  so  much  has  already  been  done,  what  may  not 
science  attain  to  in  the  future!  The  bright  vistas 
which  were  revealed  before  my  gaze  filled  me  with 
buoyant  gladness,  for  I  felt  that  the  true  road  had 
been  found  and  there  was  no  swerving  aside  from 
it.  Natura  parendo  vincitur — nature  is  conquered 
by  him  who  obeys  her;  and  when  all  her  laws  were 
fathomed,  man  would  become  her  lord  and  master  I 
The  present-day  one-sided  methods  of  treatment 
would  disappear  along  with  the  artificial  prevention 


MEDICINE'S  ACHIEVEMENT  51 

of  disease :  man  would  have  learned  to  develop  and 
render  invincible  the  curative  forces  of  his  own 
organisms,  he  would  have  no  need  to  fear  infection 
or  colds,  spectacles  and  dental  surgery  would  be- 
come unnecessary,  headaches  and  neurasthenia  ceas- 
ing to  be  known.  Man  would  be  strong,  happy  and 
healthy,  and  would  be  born  of  strong  and  healthy 
women,  the  latter  knowing  neither  the  surgeon's 
forceps,  chloroform,  nor  sec  ale  cornutum. 

But  although  my  fascination  grew,  I  could  not 
help  being  struck  at  the  tremendous  cycle  of  subjects 
embraced  by  the  study  of  medicine,  and  this  circum- 
stance disconcerted  me  not  a  little.  My  head  spun 
round  at  the  mass  of  new,  totally  divergent  infor- 
mation to  be  assimilated — which,  however,  it  was 
impossible  to  dispense  with.  We  were  busy  from 
morning  till  evening,  we  had  no  time  to  read  up 
in  medicine,  let  alone  outside  subjects.  We  were 
in  a  sort  of  fever,  flitting  from  clinic  to  clinic, 
from  lecture  to  lecture,  from  laboratory  to  labora- 
tory, in  a  kind  of  delirium.  As  in  a  rapidly  revolv- 
ing kaleidoscope  a  great  procession  of  the  most  dis- 
similar subjects  passed  before  us:  dissection  of  the 
knee-joint,  lectures  on  the  properties  of  digitalis,  the 
incoherent  ravings  of  a  paralytic  patient,  the  ap- 
plication of  accoucheur's  forceps,  the  position  oc- 
cupied by  Sydenham  in  medical  literature,  the  prob- 
ing of  the  lachrymal  canal,  the  methods  of  colour- 
ing Loeffler's  bacilli,  the  location  of  the  subclavian 


52     THE  MEMOIRS  OF  A  PHYSICIAN 

artery,  massage,  the  symptoms  of  death  from  as- 
phyxiation, ringworm,  the  various  existing  systems 
of  ventilation,  the  theory  of  chlorosis,  our  laws  on 
prostitution,  etc.,  etc.,  were  all  jumbled  up  together. 

All  this  was  absorbed  mechanically,  undigested. 
The  desire  to  reflect  on  the  information  acquired,  to 
linger  upon  this  or  that  subject,  succumbed  beneath 
the  pressure  of  that  endless  torrent  of  new  facts. 
All  that  could  be  done  was  to  store  the  latter  up 
as  mechanically,  seeking  comfort  from  the  thought, 
"Later  on,  when  I  have  more  leisure,  I  will  think  all 
over  and  put  everything  straight."  But  the  im- 
pressions obtained  gradually  became  obliterated,  the 
questions  which  arose  at  the  time  were  forgotten 
and  their  interest  was  lost;  the  assimilation  of 
knowledge  was  thus  rendered  superficial  and  school- 
boyish. 

During  our  entire  academic  course  we  hardly  ever 
had  the  chance  of  thinking  or  acting  independently. 
Our  professors  skilfully  performed  the  most  difficult 
operations  in  our  presence,  unravelled  those  compli- 
cated and  tangled  riddles  which  are  called  patients 
before  us,  while  we  .  .  .  looked  on  and  hearkened. 
Everything  seemed  to  be  so  simple,  harmonious  and 
obvious.  But  whenever  I  had  to  deal  with  a  patient 
on  my  own  initiative,  as  would  occasionally  happen, 
something  invariably  turned  up  to  nonplus  me  com- 
pletely. At  first  this  hardly  worried  me,  for  was 
I  not  a  student,  who  knew  but  little  as  yet,  and  to 


MEDICINE'S  ACHIEVEMENT  53 

whom  the  necessary  knowledge  and  experience 
would  come  later  on^  Time  passed,  however,  and 
my  knowledge  had  increased,  I  had  completed  my 
fifth  year,  the  final  examinations  were  in  progress 
— while  I  continued  to  feel  as  helpless  as  ever, 
clumsy  and  incompetent,  incapable  of  taking  the 
smallest  independent  step.  At  the  same  time  I 
could  see  that  I  was  in  no  way  behind  my  comrades ; 
on  the  contrary,  I  stood  above  the  majority.  .  .  . 
What  sort  of  physicians  would  we  become^ 

Our  final  examination  lasted  for  about  four 
months,^  These  examinations  are  especially  diffi- 
cult at  the  Faculty  of  Medicine,  owing  to  the  over- 
whelming number  of  subjects  required.  During 
the  terms  I  worked  a  great  deal,  and  I  was  endowed 
with  fair  capacity;  nevertheless,  one  was  forced  to 
read  from  ten  to  twelve  hours  daily,  as  long  as  the 
examinations  continued.  The  amount  of  knowl- 
edge demanded  of  us  was  tremendous,  at  least  three- 
fourths  being  ballast,  which  the  memory  discarded 
as  soon  as  the  tests  were  passed.  Add  to  this,  that 
most  professors  see  nothing  beyond  their  own  par- 
ticular branch  of  science  and  rarely  rise  above  their 
narrow  specialities.  One  of  my  comrades  failed 
in  anatomy  because  he  did  not  know  whether  the 
duodenum  was  covered  with  peritoneum  or  not — a 
question  of  great  interest  to  the  anatomist,  doubt- 

3  In  America  examinations  occur  at  the  end  of  each  academic 
year  and  last  approximately  one  week, 


54     THE  MEMOIRS  OF  A  PHYSICIAN 

lessly,  but  without  the  slightest  importance  for  a 
doctor. 

It  was  necessary  to  be  able  to  enumerate  the 
names  of  several  dozen  surrogates  of  milk,  although 
every  one  of  them  was  to  us  but  an  empty  sound; 
it  was  indispensable  to  have  all  the  chemical  re- 
actions of  atropin  at  one's  finger's  ends,  although 
we  had  not  experimented  upon  a  single  one  of  them 
ourselves.  .  .  . 

But  most  important  of  all  was  to  know  the  in- 
dividual hobbies  and  foibles  of  each  examiner — 
hobbies  which  were  often  wonderfully  absurd. 

The  student  who  had  neglected  to  acquaint  him- 
self with  them  was  sure  of  being  "plucked."  The 
favourite  question  of  one  of  the  professors  was  as 
follows:  "If  we  administer  an  enema  to  a  certain 
animal,  the  water  will  flow  from  its  mouth.  Pray, 
name  that  animal."  The  professor  of  general  thera- 
pathy  put  the  following  question  to  me:  "What 
is  the  difference  between  pouring  a  spoon  of  cold 
water  over  one's  head  and  swallowing  it^"  The 
professor  of  dermatology  gave  the  student  who  told 
him  that  leprosy  was  contagious  a  bad  mark;  the 
professor  of  general  surgery  marked  down  the  stu- 
dent who  gave  the  opposite  answer. 

In  a  word,  success  or  failure  depended  entirely 
upon  the  personality  and  character  of  the  examiner: 
a  "kind"  professor  passed  into  the  profession  the 
student  who  proposed  to  give  a  three-months-old  in- 


MEDICINE'S  ACHIEVEMENT  55 

fant  five  drops  of  opium;  while  a  strict  professor 
'"ploughed"  the  luckless  one  who  was  ignorant  of 
the  action  of  narceinum— an  insignificant  com- 
ponent of  that  very  same  drug. 

This  system  of  purely  school-boy  tests  turns  them 
into  a  monstrous  farce,  which  is  as  little  sensible 
as  wise.  Instead  of  the  real  knowledge  essential 
to  every  doctor,  an  incredible  jumble  is  required, 
which  it  is  possible  to  retain  in  one's  memory  only 
as  long  as  the  examinations  last. 

It  was  Virchow's  dream  once  upon  a  time  that 
doctors  should  be  subjected  to  renewed  examinations 
at  given  intervals;  as  things  stand  at  present,  such 
a  scheme,  however  reasonable  in  its  idea,  were  im- 
practicable: all  examinations  are  so  organised  that 
only  youths  with  fresh  and  elastic  memories  are 
capable  of  passing  them,  neither  experience  nor  solid 
knowledge  of  medical  science  being  essential. 

The  above  fact  is  impressed  upon  one  with  special 
force  in  the  case  of  the  "Doctor's"  examination; 
the  qualifications  for  this  test  are  practically  identi- 
cal with  those  for  the  "Surgeon's"  degree,  only  more 
comprehensive.  Queer  things  result  from  such  a 
state  of  affairs.  I  know  an  old  physician,  distin- 
guished both  as  a  practitioner  and  a  scientific  worker 
through  his  researches.  To  be  eligible  for  the  post 
of  chief  physician  of  a  hospital  he  must  bear  the 
title  of  "Doctor";  but  age  renders  him  incapable 
of  "cramming"  in  all  the  scholastic  wisdom  required 


56    THE  MEMOIRS  OF  A  PHYSICIAN 

thereto — and  he  remains  a  "Surgeon."  ^  On  the 
other  hand,  many  of  my  comrades — men  of  scant 
knowledge  and  less  experience — immediately  after 
obtaining  their  "Surgeon's"  diplomas,  with  their 
memories  still  fully  stocked,  applied  themselves  to 
tl:V  task  of  passing  their  "Doctor's"  examinations 
and  experienced  no  difficulty  in  winning  that  learned 
degree. 

Such  a  degradation  of  scholastic  honours  is  only 
possible  in  medicine;  a  mathematician  or  historian, 
who  has  not  lost  touch  with  his  subject,  can  obtain 
his  "Doctor"  at  any  moment  of  his  career,  if  so 
inclined.  If,  however,  you  were  to  subject,  after 
the  lapse  of  five  years,  a  fully-fledged  doctor  of 
medicine  to  the  same  ordeal,  without  previous  warn- 
ing, he  would  fail  ignominiously.  I  make  bold  to 
assert  that  not  a  single  eminent  physician  living 
would  be  able  to  pass  his  examinations  a  second  time 
without  laborious  preparation — unless  his  inquisi- 
tors showed  leniency  in  consideration  of  past  serv- 
ices; i.e.  were  to  require  a  real  knowledge  of  medi- 
cine— not  the  acquisition  by  rote  of  endless  minutiae 
of  no  value  whatever  to  any  one. 

*  There  is  only  one  medical  degree  in  the  United  States,  i.e. 
M.D.  (Doctor  of  Medicine).  Recently  there  has  been  another  de- 
gree conferred  upon  men  who  are  surgeons  in  well  known  hos- 
pitals.   This  is  the  F.A.C.S.  (Fellow  Am.  College  of  Surgeons). 


CHAPTER  IV 

THE   DIFFICULTIES   THAT    CONFRONT   THE    YOUNG 
PRACTITIONER 

OUR  final  examinations  terminated,  we  as- 
sembled in  the  University  hall  to  sign  our 
oaths  and  receive  our  diplomas.  The  latter  were 
em.bellished  with  the  Imperial  arms  and  the  great 
University  seal,  and  bore  witness  to  our  having  suc- 
cessfully passed  all  tests,  both  practical  and  theo- 
retical, the  Faculty  of  Medicine  declaring  us  worthy 
of  the  degree  of  Surgeon,  "with  all  the  rights  and 
privileges  appertaining  to  that  calling  according  to 
the  law." 

I  bade  good-bye  to  our  Alma  Mater  in  a  de- 
pressed and  unhappy  frame  of  mind.  The  vague 
misgivings  which  had  begun  to  assail  me  as  my  uni- 
versity career  drew  to  its  close,  at  last  assumed 
definite  shape  and  confronted  me  in  all  their  naked- 
ness. I,  whose  entire  mental  stock  consisted  of  a 
chaotic  accumulation  of  fragmentary,  undigested, 
and  unassimilated  information,  I,  who  had  hitherto 
only  looked  on  and  listened  to  others  and  never 
acted  independently,  who  was  ignorant  of  the  most 
elementary  practical  knowledge — had  suddenly  at- 
tained the  dignity  of  physician  and  patients  might 

57 


58    THE  MEMOIRS  OF  A  PHYSICIAN 

apply  to  me  at  any  moment  I  In  the  name  of  good- 
ness, what  could  I  do  for  them'? 

All  my  comrades  experienced  the  same  feelings 
as  myself.  We  looked  with  bitter  envy  upon  the 
happy  few  who  had  been  retained  in  the  clinics  as 
assistant  house-physicians.  For  they  later  would 
continue  to  learn,  working  under  the  superintend- 
ence of  experienced  and  skilled  professors,  not  at 
their  own  risk.  While  the  rest  of  us — we  had  to 
start  in  life  forthwith  as  independent  medical  men, 
not  only  enjoying  the  "rights  and  privileges,"  but 
also  bearing  the  duties  and  responsibilities  which 
the  law  imposed  upon  us  "in  accordance  with  our 
calling!" 

A  few  of  my  comrades  were  fortunate  enough  to 
obtain  hospital  appointments  elsewhere,  others 
entered  the  service  of  the  "Zemstvos";  but  those 
who  remained — including  myself — failed  to  secure 
any  such  positions,  and  the  only  thing  left  us  was 
to  try^M  gain  our  bread  by  private  practice. 

Accordingly,  I  took  up  my  residence  in  a  small 
governmental  town  of  middle  Russia.  I  arrived 
upon  the  scene  at  a  particularly  propitious  moment; 
a  short  time  previously  the  doctor,  who  lived  on 
the  outskirts  of  the  township,  and  had  worked  up 
a  fair  practice,  died.  I  took  lodgings  in  the  same 
district,  put  up  my  brass  plate  with  the  legend: 
"Dr ,"  and  began  to  wait  for  patients. 

I  awaited  them,  and  at  the  same  time  I  dreaded 


THE  YOUNG  PRACTITIONER        59 

their  advent.  Every  pull  at  the  bell  made  my 
heart  beat  in  a  panic;  each  time  that  it  turned  out 
that  no  patient  had  called,  I  sighed  with  a  feeling 
of  relief.  Would  I  be  able  to  diagnose,  would  I 
be  capable  of  prescribing  the  right  treatment  *?  My 
store  of  information  was  neither  so  large,  nor  was 
I  so  well  at  home  in  what  I  possessed,  to  feel  certain 
of  being  able  to  apply  it  impromptu.  All  well  and 
good  if  the  patient's  case  was  not  too  urgent  and 
he  could  be  allowed  to  wait :  after  prescribing  some- 
thing neutral,  I  would  look  up  my  text-books  at 
home  and  ascertain  the  right  thing  to  be  done.  But 
what  if  I  were  called  to  an  emergency  case?  It  is 
just  this  sort  of  case  that  beginners  are  generally 
summoned  to.  .  .  .  What  would  I  do  then? 

There  is  a  book  by  a  certain  Dr.  L.  Blau,  called 
"Diagnostics  and  Therapeutics  in  cases  showing 
Alarming  Symptoms."  I  got  it  and  transcribed  its 
main  contents  into  my  pocket  memoranda,  supple- 
menting this  conspectus  from  my  text-books.  I 
grouped  the  different  diseases  in  accordance  with 
their  symptoms;  for  instance,  dyspncea:  (1)  croup; 
(2)  pseudo-croup;  (3)  oedema  of  the  glottis;  (4) 
spasm  of  the  larynx;  (5)  bronchial  asthma;  (6) 
congestion  of  the  lungs;  (7)  croupous  pneumonia; 
(8)  uremic  asthma;  (9)  pleurisy;  (10)  pneumo- 
thorax. Each  disease  in  turn  was  accompanied  by 
an  enumeration  of  its  symptoms  and  the  correspond- 
ing  treatment.     This   note-book   did   me   yeoman 


6o     THE  MEMOIRS  OF  A  PHYSICIAN 

service  and  I  could  not  dispense  with  it  for  a  long 
time  afterwards — about  two  years.  When  sum- 
moned to  the  bedside  of  a  patient,  I  would  unclasp 
my  trusty  friend  under  the  pretext  of  taking  notes, 
seek  out  the  disease  most  resembling  the  patient's, 
and  prescribe  accordingly. 

I  was  the  only  medical  man  in  the  part  of  the 
town  where  I  lived,  and  little  by  little  the  patients 
began  to  arrive.  ...  I  soon  worked  up  a  practice 
amongst  the  local  townspeople  which  could  be  con- 
sidered very  fair  for  a  beginner. 

Among  others  I  attended  the  wife  of  a  certain 
shoemaker,  a  woman  of  about  thirty,  suffering  from 
dysentery.  All  went  well  and  the  patient  was  on 
the  way  to  recovery,  when  one  morning  she  began 
to  complain  of  violent  pains  in  the  right  side  of 
her  stomach.  Her  husband  immediately  ran  to 
fetch  me.  I  examined  the  patient.  Pressure 
caused  diffused  pain  throughout  the  abdominal 
region,  while  that  of  the  liver  was  so  tender  that- 
she  could  not  bear  the  slightest  touch;  the  stomach, 
lungs  and  heart  were  in  good  order  and  the  tempera- 
ture was  normal. 

What  could  the  matter  be  ?  I  mentally  reviewed 
all  the  different  diseases  of  the  liver  I  knew  of  and 
could  not  fix  upon  a  single  one.  It  was  the  most 
natural  thing  in  the  world  to  connect  this  new  com- 
plication with  the  original  trouble;  in  cases  of 
dysentery,  abscesses  of  the  liver  sometimes  form; 


THE  YOUNG  PRACTITIONER        61 

but  in  the  present  instance  the  normal  temperature 
seemed  to  negative  such  a  supposition.  Having 
injected  some  morphia,  I  went  home  entirely 
baffled. 

However,  towards  evening  the  temperature  went 
up  to  104°  Fahrenheit,  violent  rigours  setting  in, 
the  patient's  respiration  became  somewhat  laboured 
and  the  pains  in  the  side  increased  in  severity.  All 
my  doubts  vanished:  an  abscess  resulting  from 
dysentery  must  have  formed  in  the  sick  woman's 
liver,  while  the  shortness  of  breath  was  accounted 
for  by  the  pressure  exercised  upon  the  lung  through 
the  swelling  of  the  first-mentioned  organ.  I  was 
really  pleased  with  myself  for  the  shrewdness  of  my 
diagnosis. 

But  once  the  patient  had  an  abscess,  an  operation 
became  imperative  (a  very  easy  thing  to  say  in  a 
clinic).  I  advised  the  husband  to  place  his  wife 
in  hospital;  I  told  him  that  the  situation  was  ex- 
tremely grave,  that  his  wife  had  an  abscess  in  her 
vitals,  and  that  if  it  ruptured  internally,  death  was 
inevitable.  He  hesitated  for  some  time,  but  finally 
allowed  himself  to  be  persuaded. 

Two  days  later,  on  calling  at  the  hospital  to  en- 
quire after  the  sufferer's  condition,  I  was  astounded 
to  hear  that  the  real  mischief  was  croupous  pneu- 
monia! I  could  hardly  believe  my  ears.  .  .  .  The 
house-physician  conducted  me  to  her  ward  and 
showed  me  my  late  patient. 


62     THE  MEMOIRS  OF  A  PHYSICIAN 

I  then  recollected  that  at  the  time  it  did  not  even 
occur  to  me  to  ask  whether  she  had  a  cough;  I  had 
not  even  repeated  my  auscultation  of  her  lungs,  so 
pleased  was  I  to  hear  of  the  rigours  and  fever  which 
I  unhesitatingly  accepted  as  an  indisputable  con- 
firmation of  my  diagnosis.  Truly,  the  thought  had 
flitted  through  my  mind  that  it  would  do  no  harm 
to  sound  the  lungs  once  more;  but  the  patient 
screamed  so  at  every  movement,  that  I  simply  did 
not  dare  examine  her. 

"But  her  abdomen  is  very  tender,"  I  ventured,  in 
confusion. 

"Yes,  there  is  a  slight  pain  in  the  liver,"  answered 
the  doctor,  "although  the  right  pleura  causes  her 
much  more  discomfort." 

I  persisted,  touching  her  stomach  almost  imper- 
ceptibly, at  which  the  patient  screamed  aloud.  The 
house-physician  then  started  chatting  with  her,  en- 
quiring about  the  previous  night,  gradually  sink- 
ing his  whole  hand  into  her  stomach  in  the  mean- 
while, without  the  sufferer  so  much  as  noticing  his 
action. 

"Now  then,  my  good  woman,  sit  up !"  he  ordered. 

"Oh,  I  can't." 

"Tut,  tut,  nonsense !     Sit  up." 

And  she  obeyed.  We  could  then  sound  her  at 
leisure :  it  was  a  most  typical  case  of  croupous  pneu- 
monia. .  .  . 


THE  YOUNG  PRACTITIONER        63 

How  could  I  have  conducted  my  previous  ex- 
aminations so  superficially  and  carelessly'? 

It  was  absolutely  indispensable  to  examine  every 
patient  from  head  to  foot,  no  matter  what  he  might 
be  suffering  from — all  our  professors  never  wearied 
of  repeating  the  above;  this  was  sufficiently  dinned 
into  our  ears,  and  at  an  examination  I  would 
have  adduced  endless  corroborative  examples.  But 
theory  is  one  thing,  practice — another.  It  struck 
me  as  absurd  to  proceed  with  the  examination  of  a 
patient's  eyes,  nose  and  heels,  because  he  or  she  com- 
plained of  indigestion.  In  these  matters  the  only 
real  teacher  is  personal  experience — theory  is  help- 
less to  force  us  to  accept  the  truth.  In  the  clinics, 
unfortunately,  we  could  not  acquire  that  experience. 

Further,  it  was  characteristic,  that  in  diagnosing, 
I  invariably  fixed  upon  the  rarest  of  all  the  diseases 
which  might  be  suspected.  The  case  just  described 
was  by  no  means  unique  in  my  practice:  I  would 
take  colic  of  the  bowels  for  the  beginning  of  peri- 
tonitis, a  simple  case  of  piles  assumed  the  aspect  of 
cancer  of  the  rectum,  and  so  on. 

My  acquaintance  with  everyday  illness  was  very 
limited — the  first  diseases  which  occurred  to  me 
were  those  serious,  rare  and  ''interesting"  cases  to 
which  I  had  become  accustomed  in  the  lecture-room. 

Nevertheless,  in  the  distinguishing  of  diseases  I 
was  still  more  or  less  sure  of  my  ground;  while  in 


64    THE  MEMOIRS  OF  A  PHYSICIAN 

college,  diagnoses  used  to  be  made  in  our  presence, 
although  we  took  but  very  little  part  in  them;  still 
we  saw  enough.  But  I  was  quite  at  sea  when  it 
came  to  predicting  the  course  that  each  patient's 
illness  would  take,  and  I  was  entirely  ignorant  of 
the  action  of  the  different  curative  remedies  pre- 
scribed by  me,  being  solely  acquainted  with  them 
through  the  text-books.  At  the  university  it  was 
considered  very  satisfactory  if  the  same  patient  were 
demonstrated  before  us  four  or  five  times.  During 
my  whole  student  life  I  only  had  the  opportunity  of 
following  from  beginning  to  end  the  maladies  of  ten 
or  fifteen  patients,  when  appointed  by  the  professor 
to  watch  their  cases.  Such  a  small  number  is  just 
about  as  good  as  none  at  all. 

One  day,  about  a  couple  of  months  after  settling 
down  in  practice,  I  was  requested  to  call  on  the  wife 
of  a  certain  cloth  manufacturer;  this  was  the  first 
occasion  upon  which  I  was  asked  to  a  wealthy 
patient.  So  far  my  clientele  had  been  made  up  of 
mechanics,  small  shopkeepers,  petty  officials,  and 
so  on. 

"Have  you  been  in  practice  long?"  was  the  first 
question  my  patient,  a  young  and  intellectual  look- 
ing lady  of  about  thirty,  asked. 

Ashamed  to  tell  a  lie,  although  longing  to  say 
"Two  years,"  I  answered  truthfully. 

"Well,  I  am  very  glad!"  was  the  satisfied  re- 
joinder.    "That  means  that  you  are  abreast  of  the 


THE  YOUNG  PRACTITIONER        6^ 

times;  to  be  candid,  I  feel  much  greater  confidence 
in  young  doctors  than  in  all  these  'celebrities':  the 
latter  have  forgotten  everything,  and  merely  try  to 
hypnotise  us  with  their  reputations." 

The  patient  was  suffering  from  acute  rheumatism 
of  the  joints — as  it  chanced,  one  of  those  complaints 
for  which  medicine  possesses  an  efficacious  specific 
remedy  in  the  shape  of  salicylic  acid.  No  case  could 
have  been  more  favourable  for  a  first  debut. 

'Will  her  illness  last  for  long,  doctor*?"  the 
patient's  husband  asked  in  the  hall. 

"N — ^no!"  I  answered.  "The  pains  ought  to  be- 
come less  every  day  and  her  condition  will  improve, 
only  see  that  the  medicine  is  taken  regularly." 

A  few  days  later  the  following  note  reached  me : 
"Sir!  not  only  is  my  wife  no  better,  but  she  feels 
much  worse.     Be  so  kind  as  to  call." 

I  came.  At  first  the  patient's  right  knee  and  left 
foot  had  been  affected ;  now  she  felt  pains  in  the  left 
shoulder  joint  and  left  knee  in  addition.  I  was 
greeted  with  a  cold  and  unfriendly  stare. 

"Why,  doctor,  you  told  me  that  I  should  be  well 
soon,"  she  said,  "but  I  get  worse  and  worse.  Oh! 
such  terrible  pains.  My  God!  I  never  imagined 
that  such  sufferings  were  possible !" 

So  much  for  my  sodium  salicylate — that  sure 
specific ! 

I  silently  began  to  remove  the  cotton-wool  im- 
pregnated with  an  ointment  of  vaseline  and  chloro- 


66     THE  MEMOIRS  OF  A  PHYSICIAN 

form,  in  which  were  enveloped  the  affected  joints. 

"I  wonder  whether  it  is  the  ointment  which  has 
that  putrid  smell,  or  whether  I  am  beginning  to 
decompose  while  still  alive!"  the  patient  ejaculated 
capriciously.  "If  I  am  to  die,  let  me  die;  I  don't 
care  I     But  why  should  I  be  made  to  suffer  so'?" 

"Compose  yourself,  madam!  How  can  you  lose 
heart  in  that  way!"  I  remonstrated.  "There  can 
be  no  question  of  dying,  you  will  soon  be  quite 
well." 

"Oh,  yes,  you  say  so  to  console  me.  And  shall 
I  continue  to  suffer  like  this  for  long'?" 

I  vouchsafed  an  evasive  answer  and  promised  to 
call  on  the  morrow. 

Next  day  the  pain  had  considerably  subsided,  the 
temperature  had  fallen,  my  patient  looked  bright 
and  cheery.  She  warmly  shook  me  by  the  hand. 
"I  believe  I  am  getting  better  at  last!"  she  said. 
"Confess,  doctor,  that  I  have  been  a  horrid 
nuisance.  My  husband  took  me  to  task  and  I  am 
ashamed  of  my  impatience.  Tell  me,  can  I  now 
hope  that  things  will  begin  to  mend  at  last^" 

"Certainly!  You  expected  the  salicylic  powders 
to  work  like  magic,  which  was  impossible.  They 
may  not  take  effect  as  promptly  as  one  might  wish, 
but  their  action  is  sure.  Mind  you  keep  on  taking 
them." 

"But  they  make  me  perspire  very  much;  last 
night  I  had  to  change  my  chemise  three  times." 


THE  YOUNG  PRACTITIONER        67 

"Have  you  felt  any  buzzing  in  the  ears^" 

"No." 

"Then  continue  the  powders,  unless  you  want  the 
rheumatism  to  become  acute  once  more." 

"Oh,  no,  no!"  she  laughed.  "I  would  rather 
change  my  things  a  dozen  times." 

Next  day  I  called  again.  My  patient  did  not 
stir  when  I  entered  the  room.  However,  at  last  she 
unwillingly  turned  her  head  in  my  direction;  her 
face  was  drawn  and  there  were  dark  circles  beneath 
her  eyes. 

"My  right  shoulder  has  begim  to  ache,  doctor," 
she  slowly  said,  eyeing  me  with  hatred.  "I  couldn't 
sleep  the  whole  of  last  night  for  the  pain,  although 
I  have  been  taking  your  salicylic  powders  religiously. 
I  suppose  this  comes  as  a  surprised" 

Alas,  she  was  right  there!  Perhaps  it  had  been 
a  mistake  to  promise  a  rapid  recovery  from  the  be- 
ginning: my  text-books  made  the  reservation  that 
salicylic  acid  was  sometimes  inefficacious  in  the  case 
of  rheumatism;  but  I  never  suspected  that  once  it 
had  begun  to  work,  its  action  could  be  suddenly 
arrested  without  visible  cause.  The  books  were 
schematic  perforce,  and  it  was  only  natural  that  I, 
who  had  to  rely  upon  them  exclusively,  should  be 
no  different. 

On  taking  my  leave,  I  was  not  asked  to  call  again. 
However  wounded  I  might  have  felt  at  this  slight, 
nevertheless,  in  my  inmost  soul,  I  was  glad  to  be  rid 


68    THE  MEMOIRS  OF  A  PHYSICIAN 

of  my  capricious  patient,  for  she  had  worried  and 
harassed  me  exceedingly. 

Generally  speaking,  there  was  little  to  cheer  me 
in  my  practice  at  large.  I  was  chronically  in  a 
terribly  nervous  state.  Although,  goodness  knows, 
I  had  appraised  my  medical  knowledge  at  a  very 
humble  figure,  when  it  came  to  the  point  I  found 
that  even  my  modest  estimation  had  been  too  high. 
I  was  on  the  verge  of  giving  up  in  despair,  for  nearly 
every  case  disclosed  to  me  more  and  more  plainly  all 
the  depth  of  my  ignorance,  my  utter  unpreparedness 
and  incompetence.  My  abstract  bookish  wisdom, 
which  had  not  stood  the  test  of  experience,  prepared 
constant  pitfalls.  Actual  life  could  not  adapt  itself 
to  the  stiff  and  unpliable  moulds  furnished  by  my 
erudition  which,  on  the  other  hand,  I  was  incapable 
of  rendering  more  elastic.  So  often  did  I  err  in  my 
diagnoses  and  prognostications,  that  I  was  ashamed 
to  look  my  patients  in  the  face.  When  asked 
whether  the  medicine  prescribed  would  be  palatable, 
I  was  unable  to  answer;  it  generally  happened  that 
I  had  never  set  eyes  on  it  before,  much  less  tasted  it. 
The  bare  idea  of  being  summoned  to  a  complicated 
case  of  child-birth  threw  me  into  a  cold  sweat:  while 
at  the  university,  I  had  only  assisted  at  five  confine- 
ments, and  the  only  thing  I  knew  well  in  midwifery 
was  the  great  danger  arising  from  unskilled  assist- 
ance. 

To  me  the  life  and  the  soul  of  the  patient  were  a 


THE  YOUNG  PRACTITIONER        69 

closed  book;  we  used  to  visit  the  clinical  wards  in 
the  guise  of  *'young  gentlemen,"  passing  ten  or 
fifteen  minutes  at  the  bedside  of  each  patient;  we 
barely  had  time  to  give  their  diseases  the  necessary 
attention;  as  for  the  suffering  fnan^  he  remained  an 
entirely  unknown  quantity. 

But  why  should  I  dwell  upon  such  subtleties  as 
the  psychology  of  the  patient?  The  simplest  things 
constantly  found  me  wanting.  It  was  mortifying 
to  discover  that  I  lacked  that  knowledge  and  ad- 
dress which  every  nurse  possesses.  When  ordering 
an  enema  or  poultice,  I  was  in  constant  fear  of  being 
asked  how  they  should  be  applied.  As  students, 
we  were  never  instructed  in  such  "trivial"  details: 
that  was  the  hospital  attendant's  or  the  nurse's  work, 
the  doctor  merely  issuing  his  orders.  Having 
neither  hospital  attendants  nor  nurses  to  do  my 
bidding  now,  I  was  compelled  to  give  instructions 
personally  to  those  who  asked  for  them.  The 
larger  and  more  "serious"  text-books  had  to  be  laid 
aside;  their  place  was  taken  by  such  works  as 
"Nursing,"  by  Billroth,  a  primer  written  for  Sisters 
of  Mercy.  And  I,  who  had  artistically  amputated 
a  corpse's  knee  according  to  Sabaneeff's  method, 
when  passing  my  final  examinations,  now  conscien- 
tiously studied  the  methods  of  lifting  a  weak  patient 
up  in  bed  and  the  technique  of  blistering. 

Not  far  from  where  I  lived  resided  an  old  doctor, 
Ivan  Semenovitch  N.  by  name,  who  had  retired 


70     THE  MEMOIRS  OF  A  PHYSICIAN 

from  practice  on  account  of  old  age.  If  ever  these 
pages  should  meet  his  eye,  may  he  once  more  accept 
my  warm  gratitude  for  the  kind  S5^mpathy  he  showed 
me  during  that  trying  period  of  my  career  I  I  used 
to  unbosom  myself  to  him  about  my  perplexities 
and  mistakes,  would  ask  his  advice  on  all  knotty 
questions,  and  even  dragged  him  about  with  me  to 
see  my  patients.  With  purely  paternal  responsive- 
ness, Ivan  Semenovitch  was  ever  ready  to  come  to 
my  assistance  with  his  knowledge  and  experience, 
or  to  help  me  in  any  other  way  that  lay  within  his 
power.  And  every  time  that  we  stood  together  at 
the  bedside  of  a  patient — ^he  calm,  confident  and 
resourceful,  I  helpless  and  timid,  the  fact  that  we 
should  be  considered  each  other's  equals  and  pos- 
sess the  same  diplomas,  struck  me  as  a  crying  incon- 
gruity. 

One  of  my  patients,  a  grocer  in  a  small  way,  was 
suffering  from  a  very  severe  attack  of  typhoid  fever, 
complicated  by  mumps  of  the  right  gland.  Early 
one  morning  the  tradesman's  wife  urgently  sum- 
moned me  through  the  errand  boy :  her  husband  had 
become  much  worse  during  the  night  and  was  suf- 
focating. 

I  found  the  patient  in  a  semi-comatose  state:  his 
respiration  was  stertorous  and  thick,  as  if  something 
were  compressing  his  throat;  at  every  breath  his 
hypochondrium  was  deeply  drawn  in;  a  film  of 
dried  slime  of  a  brownish  hue  covered  his  teeth  and 


THE  YOUNG  PRACTITIONER        71 

the  edges  of  his  lips,  while  the  pulse  was  very  feeble. 
Owing  to  the  swelling  of  the  glands,  the  patient 
could  not  properly  open  his  mouth,  which  prevented 
my  examining  his  throat.  Under  the  pretext  of 
fetching  my  syringe  to  inject  some  camphor,  I 
hastened  home,  and  sat  down  to  study  those  chap- 
ters of  my  text-books  which  dealt  with  typhoid. 
That  difficulty  in  breathing  had  to  be  accounted 
for,  and  the  only  thing  indicated  by  my  authorities 
was  oedema  of  the  glottis,  owing  to  inflammation 
of  the  arytenoid  cartilage.  In  such  a  contingency 
my  note-book  ordered  the  following  treatment: 
"energetic  laxatives,  swallowing  of  small  lumps  of 
ice;  if  neither  take  effect,  immediate  tracheotomy." 
I  went  back  to  my  patient,  injected  some  camphor 
subcutaneously,  ordered  ice,  and  sent  to  the  chemists 
for  one  of  the  most  powerful  purgatives  known, 
colocynth. 

I  came  again  a  few  hours  later.  Notwithstand- 
ing colocynth  having  taken  effect,  the  patient's 
breathing  had  become  still  more  laboured.  Tra- 
cheotomy alone  remained.  I  went  for  Ivan 
Semenovitch.  He  attentively  listened  to  what  I 
had  to  say  and  merely  shook  his  grey  head.  A  mo- 
ment later  we  were  driving  away  together. 

On  examining  the  patient,  Ivan  Semenovitch 
made  him  sit  up,  filled  an  indiarubber  bulb  with 
warm  water,  and  introducing  the  mouthpiece  be- 
tween the  patient's  teeth,  syringed  out  his  mouth; 


72     THE  MEMOIRS  OF  A  PHYSICIAN 

a  lot  of  sticky  and  oozy  slime  came  out.  The  pa- 
tient sat  coughing  and  spluttering  while  Ivan  Se- 
menovitch  energetically  continued  his  syringings;  I 
marvelled  that  he  should  have  no  fear  of  the  patient 
choking.  Each  time  more  and  more  of  the  stuff 
came  out.  I  was  amazed  to  see  what  an  incredible 
quantity  of  slime  could  be  contained  in  the  mouth 
of  a  single  man. 

"Now  then,  cough  it  up,  spit  it  out!"  repeated 
Ivan  Semenovitch  loudly  and  imperiously.  And 
the  patient  came  round,  blowing  and  spluttering. 

His  breathing  was  quite  free  by  now.  "To  think 
that  I  had  prescribed  colocynth,"  I  muttered  in  dire 
confusion,  when  we  left  the  sick-room. 

"Oh,  oh,  oh!"  said  Ivan  Semenovitch,  shaking 
his  head,  "and  the  patient  so  weak  too!  It  doesn't 
take  long  to  kill  a  man  that  way,  and  what  the 
dickens  was  there  to  suggest  such  treatment? 
When  a  man  lies  unconscious  and  can  hardly  swal- 
low, it's  the  most  natural  thing  in  the  world  for  a 
lot  of  muck  to  collect  in  his  mouth." 

Of  course,  the  books  never  hinted  at  the  possi- 
bility of  such  "complications"  in  typhoid,  because 
they  could  not  foresee  every  minute  contingency. 

My  dejection  was  profound:  I  was  so  stupid  and 
unresourceful  that  I  would  never  make  a  doctor; 
my  competence  went  no  further  than  that  of  a  com- 
mon hospital  attendant  only  able  to  act  according 
to  cut-and-dried  routine.     Now  my  despair  strikes 


THE  YOUNG  PRACTITIONER        73 

me  as  ludicrous:  as  students,  the  necessity  of  in- 
dividualising in  each  case  was  constantly  being  im- 
pressed upon  us,  but  the  faculty  could  only  be 
acquired  through  time  and  experience. 

But,  at  the  period  described,  things  appeared  in 
a  very  different  light. 

Thanks  to  what  incredible  misunderstanding  had 
I  become  possessed  of  my  medical  certificate? 
Every  day  this  question  arose  before  me  with  more 
and  more  insistence;  for  my  right  to  call  myself  a 
doctor  merely  on  the  strength  of  that  document 
misgave  me  not  a  little,  while  life  cried  with  ever 
growing  emphasis:     "No,  you  have  no  such  right  I" 

At  last  a  thing  came  to  pass,  the  bare  recollection 
of  which  plunges  me  into  sadness  and  horror. 

On  the  very  outskirts  of  our  town,  in  a  tumble- 
down cottage,  dwelt  a  widowed  washerwoman  with 
her  three  children.  Two  of  these  died  in  hospital 
of  scarlet  fever,  and  soon  after  their  death,  her  only 
remaining  child — a  gaunt,  ugly  boy  of  about  eight 
years  of  age- — sickened.  His  mother  decided  to 
nurse  him  at  home,  unable  to  bring  herself  to  send 
him  to  hospital.  She  applied  to  me.  Her  boy  had 
the  fever  in  a  very  bad  form:  he  was  delirious  and 
tossed  about  restlessly;  his  temperature  was  105° 
Fahrenheit,  and  his  pulse  could  hardly  be  felt. 
After  having  examined  the  patient,  I  told  the  mother 
that  his  recovery  was  very  doubtful.  The  poor 
washerwoman  fell  on  her  knees  before  me. 


74    THE  MEMOIRS  OF  A  PHYSICIAN 

"Oh,  sir,  save  him  I  He  is  the  only  one  left  me! 
I  was  rearing  him  to  be  a  support  and  comfort  to 
me  in  my  old  age.  I  will  pay  you  all  I  can,  I  will 
wash  for  you  for  nothing  as  long  as  I  live!" 

The  boy's  life  hung  in  the  balance  for  a  week. 
At  last  the  fever  abated,  the  rash  grew  faint,  the 
patient  began  to  recover;  and  that  sickly  boy,  with 
ugly  peeling  face  and  apathetic  stare,  became  dear 
to  me.  His  happy  mother  thanked  me  raptur- 
ously. 

A  few  days  later  the  patient's  fever  returned,  and 
the  right  submaxillary  gland  became  swollen  and 
painful.  The  swelling  increased  day  by  day.  For 
the  moment  no  danger  threatened;  if  the  worst  came 
to  the  worst,  suppuration  might  set  in  and  an  ab- 
scess form.  Still,  I  relished  the  possibility  of  such 
a  complication  very  little.  If  an  abscess  formed, 
it  would  have  to  be  opened;  the  incision  would 
have  to  be  made  in  the  neck,  which  contains  a  great 
number  of  veins  and  arteries.  I  was  afraid  that 
if  I  severed  some  important  vessel  by  accident,  I 
should  be  unable  to  stop  the  haemorrhage.  Hitherto 
I  had  never  touched  the  living  flesh  with  my  knife. 
Of  course  I  had  seen  the  most  complicated  and  diffi- 
cult operations  performed,  but  now,  left  to  my  own 
devices,  I  was  afraid  of  the  slitting  of  an  ordinary 
gathering ! 

In  the  first  stages  of  inflammation  of  the  glands, 
treatment   with  grey  ointment   is   very  beneficial; 


THE  YOUNG  PRACTITIONER        75 

when  applied  in  time  it  often  arrests  the  inflamma- 
tion before  suppuration  has  had  time  to  set  in.  Ac- 
cordingly, I  made  up  my  mind  to  treat  my  patient 
with  the  mercurial  ointment. 

The  swelling  was  very  painful  and  therefore  I 
rubbed  the  stuff  in  very  lightly  at  first.  Next  day 
the  boy  looked  brighter,  ceased  to  complain,  his 
temperature  went  down;  he  smiled  and  asked  for 
food.  The  glands  were  much  less  tender.  I  re- 
peated my  application  of  the  salve,  this  time  rub- 
bing it  in  more  vigorously.  His  mother  almost  wor- 
shipped the  ground  I  trod  and  bitterly  regretted 
that  I  had  not  attended  her  other  children;  she  was 
sure  I  would  have  saved  them. 

On  coming  to  see  the  patient  next  day,  I  found 
that  an  abrupt  change  for  the  worse  had  taken  place. 
The  boy  lay  on  his  back  with  his  head  bent  to  one 
side  and  moaned  continuously;  in  the  right  supra- 
clavicular fossa,  below  the  original  swelling,  a  large 
new  one  stood  out  red  and  angry.  I  went  pale  and 
began  to  examine  my  patient  with  throbbing  heart. 
The  thermometer  registered  103°  Fahrenheit  the 
right  elbow-joint  was  swollen  and  so  painful  that  it 
could  not  bear  the  slightest  touch. 

The  mother,  although  much  alarmed,  followed 
my  movements  with  confidence  and  hope.  ...  I 
went  away  utterly  wretched.  No  need  to  break  my 
head — it  was  as  clear  as  day :  my  massage  had  driven 
the  pus  all  over  the  boy's  system,  general  blood- 


76     THE  MEMOIRS  OF  A  PHYSICIAN 

poisoning  had  set  in,  and  he  was  doomed  to  a  cer- 
tainty. 

All  day  I  roamed  about  the  streets  aimlessly, 
plunged  into  a  state  of  numb  stupor:  I  could  think 
of  nothing,  and  my  soul  was  gripped  by  a  feeling 
of  horror  and  despair.  Every  now  and  then  the 
thought:  "Why,  I  have  killed  a  human  being!" 
stood  out  in  my  consciousness  with  merciless  vivid- 
ness. Self-delusion  was  out  of  the  question;  things 
could  not  have  been  plainer  if  I  had  deliberately  cut 
the  boy's  throat  with  my  own  hand. 

The  patient  lingered  for  over  a  week;  every  day 
new  and  new  abscesses  formed  in  his  joints,  in  his 
liver,  in  his  kidneys.  .  .  .  He  suffered  unspeakably, 
and  all  that  could  be  done  was  to  inject  morphia. 
I  came  to  see  him  several  times  daily.  When  I 
entered  the  room,  I  was  greeted  by  the  suffering 
eyes  and  the  drawn  and  darkened  face  of  the  child; 
with  clenched  teeth,  he  groaned  pitifully  without 
intermission.  His  mother  already  knew  that  there 
was  no  hope. 

At  last,  one  evening,  when  I  entered  the  hovel, 
I  saw  my  patient  laid  out  on  the  table.^  All  was 
over.  .  .  .  With  a  strange  feeling  of  tortured  curi- 
osity I  approached  the  corpse.  The  setting  sun  illu- 
minated the  wax-like  pinched  features  of  the  boy. 
His  face  wore  an  expression  of  sorrowful  reverie, 

^  In  Russia  it  is  customary  to  lay  the  dead  out  on  a  table  cov- 
ered with  a  white  cloth. — Translator. 


THE  YOUNG  PRACTITIONER        77 

and  his  eyebrows  were  contracted.  While  I,  who 
gazed  upon  him,  was  his  murderer.  .  .  . 

The  bereaved  mother  sobbed  in  a  comer.  Dusty 
cobwebs  hung  from  the  bare  walls  of  that  miserable 
abode,  the  dirty  earthen  floor  smelt  of  damp,  all  was 
cold,  cold  and  empty.  With  a  lump  rising  in  my 
throat  I  went  up  to  the  mother  and  essayed  to  con- 
sole her. 

Half  an  hour  later,  as  I  was  on  the  point  of  tak- 
ing my  departure,  the  washerwoman  opened  her  box 
and  offered  me  a  greasy  three-rouble-note. 

"Take  it,  sir  .  .  .  for  your  trouble,"  she  said. 
"Oh,  how  you  tried  to  save  him,  may  our  Mother 
in  Heaven  bless  you  I" 

I  declined  the  fee.  We  stood  together  in  the 
semi-dark  passage. 

"It  was  God's  will  I"  I  murmured,  looking  away. 

"His  holy  will.  He  knows  best,"  she  answered, 
and  once  more  her  lips  began  to  tremble  and  her 
sobs  broke  forth  afresh.  "Oh,  thank  you,  thank 
you,  sir,  for  having  been  so  good  to  my  boy  I"  .  .  . 

And  she  tried  to  kiss  my  hand,  still  crying,  thank- 
ing me  for  my  kindness  and  consideration.  .  .  . 

•  «  •  •  •  •  • 

No!  I  would  throw  everything  up,  renounce  all 
and  go  to  St.  Petersburg  to  study  further,  even  if  I 
starved  in  the  attempt. 


CHAPTER  V 

YOUNG    DOCTORS    AND    TECHNIQUE 

ON  my  arrival  in  St.  Petersburg  I  registered  for 
the  courses  at  the  Helena  Clinical  Institute. 
That  institution  is  specially  intended  for  medical 
men  who  are  anxious  to  perfect  themselves  further. 
After  a  brief  attendance,  however,  it  was  borne  upon 
me  that  I  would  derive  but  little  from  those  courses, 
for  the  system  was  identical  with  that  existing  at 
the  University;  once  more  we  were  allowed  to  look 
on  ad  infinitum  and  there  the  matter  ended.  I  con- 
sidered that  I  had  done  so  quite  sufficiently  as  it 
was.  These  lectures  are  very  useful  to  doctors  who 
have  already  been  long  in  practice  and  accumulated 
many  questions  demanding  an  answer;  but  for  us 
beginners  they  were  of  small  value :  we  chiefly  stood 
in  need  of  hospital  work  under  the  direction  of  ex- 
perienced mentors. 

I  began  to  hunt  for  a  suitable  position.  I  would 
have  been  satisfied  with  the  wretchedest  pay,  for 
my  ambition  did  not  go  beyond  what  would  suffice 
to  keep  me  in  bread  and  cheese  and  from  sleeping 
on  the  doorstep — for  I  had  no  private  means  what- 
ever. 

I  visited  all  the  hospitals  in  turn,  interviewed 

78 


YOUNG  DOCTORS  AND  TECHNIQUE     79 

all  the  chief-physicians;  they  received  me  with  cold 
nonchalant  civility,  invariably  informing  me  with 
a  superior  smile  that  there  were  no  vacancies,  ex- 
plaining further  that  I  was  mistaken  in  thinking  it 
were  possible  to  obtain  a  salaried  hospital  appoint- 
ment for  the  mere  asking.  Soon  I  myself  under- 
stood plainly  how  naive  such  hopes  had  been. 

In  every  hospital  dozens  of  doctors  work  gratis; 
those  who  aspire  to  the  beggarly  pay  of  house- 
physician  must  wait  from  five  to  ten  years;  the  ma- 
jority do  not  even  expect  anything  of  the  kind,  and 
give  their  services  in  exchange  for  that  which  their 
colleges  ought,  but  have  failed,  to  supply.  Various 
corporations  avail  themselves  widely  of  the  advan- 
tages to  themselves  resulting  from  such  a  state  of 
affairs,  especially  our  municipalities,  which  accord- 
ingly exploit  the  faculty  to  an  incredible  extent. 
It  is  not  the  same  everywhere,  however.  The 
Copenhagen  municipality  helps  to  serve  the  ends  of 
medical  education  by  liberally  distributing  appoint- 
ments amongst  young  doctors  in  the  city  hospitals, 
at  the  same  time  cutting  down  the  term  of  service 
to  two  years,  so  as  to  make  room  for  fresh  candi- 
dates. Throughout  France  the  municipal  hospitals 
likewise  act  in  the  same  liberal  spirit.  While  in 
1894  one  of  the  members  of  the  Town  Council  of 
St.  Petersburg  proposed  that  the  salaries  of  the 
physicians  of  the  municipal  hospitals  be  entirely 
withdrawn,  because  there  would  always  be  a  suffi- 


8o    THE  MEMOIRS  OF  A  PHYSICIAN 

cient  number  of  applicants  content  to  give  their 
services  gratis.  "Doctors,"  he  declared,  "ought  to 
be  glad  of  being  given  mere  access  to  the  hospitals." 

I  gave  up  all  hope  of  obtaining  a  salaried  posi- 
tion and  entered  myself  at  one  of  the  hospitals  as  a 
"Supernumerary."  I  often  found  myself  in  the 
greatest  want:  in  the  evening  I  used  to  trim  the 
"fringes"  of  my  trousers  and  mend  the  rents  in  my 
boots  with  black  thread;  I  used  to  envy  my  patients 
when  ordering  them  extras,  because  I  myself  sub- 
sisted mainly  on  bread  and  cheap  sausage.  During 
those  hard  times  I  experienced  and  came  to  under- 
stand a  phenomenon  which  was  formerly  quite  be- 
yond my  comprehension — how  one  could  take  to 
drink  through  hunger. 

At  that  period,  whenever  I  passed  a  public-house, 
it  had  an  irresistible  attraction  for  me;  at  such  mo- 
ments I  used  to  think  that  it  was  the  height  of  bliss 
to  step  up  to  the  brilliantly  illuminated  bar,  cov- 
ered with  tempting  "zakouskas,"  and  to  toss  off  a 
glass  or  so  of  vodka;  strange  to  say,  half-starved 
as  I  was,  the  spirits  attracted  me  more  than  the  eat- 
ables, although  I  was  never  a  dipsomaniac.  When 
I  had  a  rouble  in  my  pocket,  I  could  not  resist  the 
temptation,  and  got  drunk.  Never  before  or  after, 
when  I  was  properly  nourished,  did  vodka  have  any 
fascinations. 

There  was  a  great  deal  of  work  at  the  Infirmary, 
and  it  was  plain  to  me  that  my  labour  was  simply 


YOUNG  DOCTORS  AND  TECHNIQUE     81 

indispensable  to  the  hospital;  the  amiability  ex- 
tended to  me,  whereby  I  was  "allowed"  to  perform 
my  duties,  being  of  the  same  order  as  the  philan- 
thropy of  the  contractor  who  "gives  bread"  to  his 
workmen,  only  with  this  difference:  the  bare  per- 
mission to  work  was  all  the  pay  I  received  for  my 
services.  When  I  returned  home  dead  beat  and 
broken,  after  a  sleepless  vigil,  and  cogitated  pro- 
foundly as  to  the  most  nourishing  dinner  that  could 
be  procured  for  eight  kopecks  (4  cents),  I  used  to 
be  seized  with  rage  and  despair:  to  think  that  in 
return  for  this  drudgery  I  could  not  even  claim  the 
right  to  be  decently  fed  I  And  I  would  begin  to 
repent  having  thrown  up  my  practice  and  come  to 
St.  Petersburg,  Billroth  says  that  only  a  doctor 
without  a  drop  of  conscience  can  permit  himself 
without  more-a-do  to  make  use  of  the  rights  which 
his  diploma  gives  him.  But  who  were  to  blame? 
Not  we!  It  was  the  public's  fault  that  we  had  no 
other  alternative  open  to  us — so  let  them  pay  the 
piper  I — I  thought  vindictively. 

In  addition  to  my  regular  hospital  duties,  I  con- 
tinued to  attend  certain  lectures  at  the  Clinical 
Institute  and  also  worked  in  other  hospitals.  And 
everywhere  the  scant  consideration  given  to  our 
doctor's  diplomas,  "with  all  the  rights  and  privileges 
appertaining  to  that  calling  according  to  the  law," 
by  the  medical  world,  became  niore  and  more  ap^ 
parent. 


82    THE  MEMOIRS  OF  A  PHYSICIAN 

At  our  hospital  every  prescription  I  wrote,  every 
diagnosis  I  made,  was  strictly  controlled  by  our 
chief  house-physician  for  many  a  day.  Everywhere 
I  was  only  allowed  to  prescribe  for  the  patients  and 
to  operate  upon  them  independently,  after  the  au- 
thorities had  become  convinced  in  person  of  my 
competence — they  ignored  my  certificates.  At  the 
Nadejdensky  Lying-in  Hospital  a  doctor,  desirous 
of  studying  midwifery,  for  the  first  three  months  is 
only  allowed  to  examine  the  patients  and  to  be  pres- 
ent at  the  operations;  only  at  the  close  of  this  pro- 
bationary term,  on  passing  his  "colloquium,"  is  he 
admitted  to  operate  in  person,  under  the  supervision 
of  the  resident-surgeon  on  duty.  .  .  .  Could  con- 
tempt for  our  "rights"  go  further?  My  certificate 
declares  me  to  be  a  fully  qualified  physician;  the 
law  compels  me,  under  pain  of  dire  penalties,  to 
respond  to  the  first  summons  of  midwife  in  a  diffi- 
cult confinement  case,  while  here  I  am  not  trusted 
with  the  easiest  child-bed,  and — it  must  be  admitted 
— with  entire  justification. 

"I  demand,"  wrote  the  well-known  German  sur- 
geon Langenbeck  in  1874,  "that  every  doctor  called 
to  the  battle-field  should  possess  the  technique  of 
operations  as  perfectly  as  a  fighting  soldier  wields 
his  weapons."  ... 

After  all,  who  would  think  of  sending  into  battle 
soldiers  who  had  never  held  rifle  in  hand  and  had 
only  seen  others  shoot?     And,  nevertheless,  doctors 


YOUNG  DOCTORS  AND  TECHNIQUE     83 

not  only  go  to  the  battle-field,  but  enter  upon  life, 
in  the  guise  of  clumsy  recruits  unable  to  handle 
their  arms. 

The  medical  press  of  all  countries  exhausts  itself 
in  its  clamour  for  reform,  which  should  render  such 
a  crying  contradiction  impossible,  but  unavailingly. 
How  is  this*?  I  am  absolutely  at  a  loss  to  suggest 
any  explanation.  Whose  interests  would  suffer, 
were  the  fact  clearly  established  that  practical 
preparation  is  absolutely  essential,  if  doctors  are  to 
perform  their  duties  conscientiously*?  Of  course  not 
those  of  society,  no  more  than  of  the  faculty,  which 
is  ever  repeating  to  the  public:  "Pray  understand 
that  we  learn  upon  you^  that  we  obtain  experience 
at  the  expense  of  your  lives  and  healths !" 


CHAPTER  VI 

THE   ART  AND  INEVITABLE   RISKS  OF   SURGERY 

I  WORKED  indefatigably  at  our  hospital,  and 
under   the   direction   of  my   elder   colleagues, 
gained  experience  by  degrees. 

So  far  as  that  experience  concerned  prescribing 
and  treatment,  things  were  fairly  simple  and  went 
smoothly  enough;  I  prescribed  or  gave  my  orders, 
and  if  I  made  a  mistake,  a  senior  comrade  pointed 
out  the  fact  and  I  rectified  my  error.  But  matters 
assumed  a  very  different  complexion  when  it  became 
necessary  to  attain  either  technical  or  operative  skill. 
Mere  instruction  did  not  suffice  here:  however  ex- 
perienced my  mentor,  that  skill  had  to  be  acquired 
by  me  personally.  Only  he  who  has  the  habit,  can 
operate  with  confidence  and  composure.  But  how 
is  this  proficiency  to  be  obtained  if  you  have  not 
operated  previously,  were  it  even  with  faltering  and 
unsteady  hand^ 

In  the  middle  of  the  late  eighties  the  American 
surgeon  O'Dwyer  invented  a  new  method  of  treat- 
ment for  stricture  of  the  larynx,  threatening  danger 
to  children  suffering  from  croup.  Formerly,  in 
such  emergencies,  it  was  usual  to  perform  trache- 
otomy: the  windpipe  of  the  patient  was  opened  in 

84 


SURGERY— ITS  RISKS  8^ 

front  and  a  metal  tube  introduced  into  the  orifice. 
Instead  of  this  sanguinary  operation,  so  terrible  to 
the  relatives  of  the  patient  and  requiring  chloro- 
form and  the  assistance  of  several  doctors,  O'Dwyer 
proposed  his  own  method,  which  consisted  of  the 
following:  the  operator  inserts  his  left  index  into 
the  child's  mouth,  catches  the  epiglottis,  and  with 
his  right  hand  introduces,  by  means  of  a  special  in- 
strument, a  metal  tube  with  an  enlarged  head  which 
he  guides  along  his  left  finger  into  the  child's  larynx. 
The  tube  is  left  there;  its  enlarged  head  reposes 
upon  the  vocal  cords  and  prevents  it  from  slipping 
into  the  windpipe;  when  required  no  further,  it  is 
removed  from  the  throat.  This  operation  is  known 
under  the  name  of  "intubation,"  and  by  means  of 
it  the  most  wonderful  results  are  often  attained,  as- 
phyxiation being  immediately  arrested.  In  diph- 
theria cases  it  is  employed  more  and  more,  displacing 
tracheotomy,  which  is  only  resorted  to  now-a-days 
upon  those  comparatively  rare  occasions  when  intu- 
bation fails  to  answer. 

As  already  stated,  this  salutary  operation  is  both 
simple  and  painless  .  .  .  when  performed  by  a 
skilled  hand.  Prolonged  habit  is  necessary  for  the 
introduction  of  the  tube  into  the  larynx  of  scream- 
ing and  frightened  children  smoothly  and  without 
hitch. 

In  our  diphtheria  ward  I  worked  under  the  direc- 
tion of  a  colleague,  Stratonoff  by  name.     I  had  seen 


86     THE  MEMOIRS  OF  A  PHYSICIAN 

him  perform  intubation  dozens  of  times  and  fre- 
quently practised  it  myself  upon  corpse  and  dummy. 
At  last  Stratonoff  allowed  me  to  try  my  skill  on  a 
living  child.  The  latter  was  a  chubby  little  boy  of 
three,  with  sweet  blue  eyes.  He  tossed  about  his 
cot  fitfully,  gasping  for  air,  and  his  face  was  livid. 
They  brought  him  into  the  operating  room,  where 
he  was  placed  on  a  lounge  and  his  arms  pinioned. 
Stratonoff  opened  his  mouth  by  means  of  a  dilator, 
and  a  Sister  of  Mercy  held  the  boy's  head.  I  began 
to  introduce  the  instrument.  The  small  and  soft 
larynx  of  the  child  jumped  and  throbbed  beneath 
my  fingers  and  I  could  not  make  sure  of  its  position. 
At  last  I  thought  that  I  had  found  the  entrance  to 
the  larynx;  I  began  to  introduce  the  tube;  however, 
it  was  stopped  by  something  and  would  not  budge. 
I  pushed  harder,  but  the  tube  would  not  move. 

"Steady!  I  say,  don't  press,  you  can  gain  nothr 
ing  by  employing  force,"  remarked  Stratonoff. 
"Lift  the  handle  a  bit  and  slip  the  tube  in  without 
any  effort  whatever." 

Taking  the  intubator  out,  I  began  to  introduce  it 
afresh;  for  a  long  time  I  continued  to  fumble  about 
in  the  child's  throat  with  the  end  of  the  tube;  at 
last  it  found  its  way  in  and  I  removed  the  director. 
The  tortured  and  breathless  child  immediately  spat 
the  tube  out,  together  with  some  bloody  saliva. 

"You  had  inserted  the  tube  into  the  gullet,  not 
the  windpipe,"  said  Stratonoff.     "First  locate  the 


SURGERY— ITS  RISKS  87 

epiglottis,  firmly  press  it  forward,  retain  it  in  that 
position  and  introduce  the  tube  when  the  child  sighs. 
The  main  thing  is  to  employ  no  force  I" 

Red  and  perspiring,  I  took  breath  and  again  pro- 
ceeded with  the  operation,  trying  not  to  look  at  the 
protruding  and  agonised  eyes  of  the  child.  Its 
larynx  had  become  swollen  and  I  found  it  still  more 
difficult  to  be  sure  of  my  whereabouts.  Once  more 
the  end  of  the  tube  was  obstructed  by  something  and 
I  could  not  resist  the  impulse  to  try  and  surmount 
the  obstacle  by  violence.  ' 

"No,  I  can't  I"  I  declared  at  last,  frowning,  and 
removed  the  guide. 

Stratonoff  took  the  intubator  and  rapidly  put  it 
into  the  child's  mouth;  the  boy  struggled,  his  eyes 
starting,  his  breathing  was  arrested  for  a  second; 
Stratonoff  pressed  the  screw  and  deftly  removed 
the  director.  The  characteristic  blowing  sound  of 
breathing  through  a  tube  became  audible;  the  child 
coughed,  trying  to  eject  the  foreign  body. 

"No,  my  fine  fellow,  you  don't  this  time!"  said 
Stratonoff,  smiling  and  pinching  the  child's  cheek. 
Five  minutes  later,  the  little  fellow  was  fast  asleep^ 
breathing  freely  and  regularly. 

A  difficult  time  dawned  for  me.  It  was  abso- 
lutely necessary  that  I  should  master  intubation;  at 
the  same  time,  all  demonstrations  and  explanations 
availed  nothing,  and  my  previous  practice  on  the 
dummy  and  corpse  proved  to  be  of  small  value.     It 


88     THE  MEMOIRS  OF  A  PHYSICIAN 

was  only  after  a  week  of  failure  that  I  managed  to 
introduce  the  tube  successfully;  and  for  long  after- 
wards, when  about  to  intubate,  I  lacked  the  convic- 
tion that  I  would  be  successful. 

It  would  happen  sometimes  that  after  having  tor- 
tured the  child  and  myself  as  well,  in  the  end  I  had 
to  send  for  the  house-surgeon,  who  performed  the 
operation  for  me. 

All  this  was  terribly  hard,  but  I  had  no  choice. 
The  operation  was  so  obviously  useful  and  salutary. 
...  I  am  conscious  of  this  especially  now  that  those 
painful  experiences  are  things  of  the  past,  and  that 
I  can  undertake  to  perform  intubation  at  any  mo- 
ment and  under  any  circumstances.  Quite  recently, 
while  on  night  duty,  I  had  to  perfonPx  it  upon  a 
little  girl  of  five;  the  day  before,  the  tube  had  been 
inserted,  but  she  had  coughed  it  out.  She  was  car- 
ried into  the  operating  room  and  I  began  to  prepare 
my  instruments.  The  little  girl  sat  on  the  nurse's 
knees,  pale,  with  drops  of  sweat  on  her  forehead  and 
an  expression  of  that  terrible  depression  which  is 
peculiar  to  those  who  are  struggling  for  air.  At  the 
sight  of  the  instruments,  her  dull  eyes  brightened 
slightly;  she  opened  her  mouth  and  kept  still,  evi- 
dently following  my  movements  with  timid  and  ex- 
pectant hope.  My  heart  contracted  with  a  sweet 
spasm  of  joy.  Rapidly  and  dexterously,  delighting 
in  my  own  skill,  I  introduced  the  tube  into  the  little 
sufferer's  larynx.     The  little  girl  raised  herself  and 


SURGERY— ITS  RISKS  89 

sat  up  on  the  sofa,  taking  in  the  air  with  full  and 
greedy  breaths;  her  cheeks  regained  their  colour 
and  her  eyes  sparkled  with  happiness. 

"That's  right!  You  can  breathe  easier  now, 
can't  you?"  I  asked. 

She  silently  nodded. 

"Now  then,  dear,  say  'Thank  you'  to  the  doctor," 
put  in  the  nurse. 

"Thank  you  I"  came  the  grateful  whispered 
answer. 

On  returning  to  my  room  and  lying  down,  I 
remained  awake  for  a  long  time.  The  darkness 
seemed  to  re-echo  that  weak  lisping  "Thank  you," 
and  the  happy  childish  face  rose  up  before  me  again 
and  again.  Yes,  such  moments  soften  the  recollec- 
tion of  the  hard  road  which  it  is  necessary  for  us  to 
traverse  and  in  a  measure  reconcile  us  to  actuality; 
without  the  bitter  there  could  not  be  the  sweet. 
But  still,  those  first  ones  who  had  to  suffer  for  the 
others'  sake — what  cared  they  for  the  benefits  to  the 
latter,  purchased  at  the  price  of  their  own  martyr- 
dom? 

Alas,  this  suffering  is  incalculable.  How  many 
ruined  lives  lie  in  the  wake  of  every  doctor! 

"Our  progress  is  over  mountains  of  corpses," 
sadly  confesses  Billroth  in  one  of  his  private  letters. 

Most  vivid  of  all  stands  out  the  recollection  of 
my  first  and  only  tracheotomy;  that  experience  will 
ever  haunt  me  as  a  ghastly  nightmare.     I  had  often 


90     THE  MEMOIRS  OF  A  PHYSICIAN 

assisted  at  the  operation,  when  carried  out  by  my 
colleagues,  and  had  on  numerous  occasions  per- 
formed it  myself  upon  the  dead. 

Finally,  the  day  arrived  for  me  to  try  my  hand 
on  a  living  girl;  in  her  case  intubation  had  ceased 
to  help.  One  of  the  doctors  administered  chloro- 
form, while  Stratonoff  acted  as  my  assistant,  ready 
to  come  to  my  aid  at  any  moment. 

With  the  first  incision  I  made  in  the  white  and 
plump  throat  of  the  little  girl,  I  felt  that  I  was 
powerless  to  control  the  agitation  that  possessed  me : 
my  hands  trembled  visibly. 

''Keep  cool,  all  goes  well,"  Stratonoff  said  quietly, 
carefully  seizing  the  fascia  covered  with  blood  with 
his  forceps. 

"Retractors!  There  is  the  thyroid  gland,  detach 
the  fascia,  proceed  with  a  blunt  edge !  There,  that's 
right." 

At  last  I  reached  the  windpipe  with  my  probe, 
hurriedly  tearing  aside  the  loose  tissue  and  parting 
the  black,  swelling  veins. 

"Have  a  care,  don't  press  so,"  said  Stratonoff. 
"Why,  man,  you'll  break  all  the  cartilages  of  the 
trachea  at  that  rate!     Don't  hurry!" 

The  smooth  gristly  rings  of  the  windpipe  moved 
regularly  beneath  my  fingers  with  the  child's  respi- 
ration; I  fixed  it  with  a  retractor  and  made  an 
incision;  the  air  began  to  whistle  faintly  through 
the  aperture. 


SURGERY— ITS  RISKS  91 

"Dilator!" 

I  introduced  the  latter  into  the  incision.  .  .  . 
Thank  God,  it  would  soon  be  over !  But  that  char- 
acteristic hissing  sound,  which  shows  that  the  air 
has  free  egress,  was  absent. 

"You  have  missed  the  right  opening;  you  have 
introduced  the  dilator  into  the  mediastinum  I"  sud- 
denly exclaimed  Stratonoff  nervously.  I  pulled  the 
instrument  out  and,  with  fingers  trembling  from 
excitement,  inserted  it  a  second  time,  going  astray 
once  more.  I  was  losing  my  head  fast.  The,  deep 
fimnel-shaped  wound  kept  filling  with  blood,  which 
a  Sister  of  Mercy  promptly  soaked  up  with  wads  of 
cotton-wool;  the  blood  frothed  at  the  bottom  of  the 
wound  from  the  air  which  escaped  through  the  dis- 
sected trachea;  the  incision  itself  was  hideous  and 
jagged,  while  a  little  lower  down  yawned  the  aper- 
ture caused  by  my  clumsy  introduction  of  the  di- 
lator. The  Sister  of  Mercy  stood  by  with  suffering 
face,  and  the  nurse  holding  the  little  girl's  legs  bent 
her  head  low,  so  as  not  to  see.  .  .  . 

Stratonoff  took  the  dilator  from  me  and  began  to 
insert  it  himself.  For  a  long  time  he  had  great 
difficulty  in  locating  my  incision,  but  finally  suc- 
ceeded :  a  hissing  noise  resounded  and  a  fit  of  cough- 
ing expelled  drops  of  bloody  slime.  Introducing 
the  canula,  Stratonoff  bent  down  and  began  to  suck 
the  blood  out  of  the  windpipe. 

"Colleague,  it  is  self-evident  and  needs  no  expla- 


92     THE  MEMOIRS  OF  A  PHYSICIAN 

nation,"  he  said,  when  the  operation  was  over,  "the 
incision  ought  to  be  made  in  the  very  middle  of 
the  trachea,  while  you  somehow  managed  to  make 
it  at  the  side.  And  why  on  earth  did  you  make 
such  a  long  cut?" 

"Why  I"  Upon  the  corpses  my  incisions  were 
of  the  proper  length  and  situated  exactly  in  the 
middle  of  the  windpipe. 

The  child  developed  diphtheria  of  the  wound. 
The  dressing  had  to  be  changed  twice  a  day,  the 
temperature  keeping  at  104°  Fahrenheit.  The  tube 
would  not  hold  firm  in  the  tremendous  suppurating 
funnel-shaped  wound;  it  became  necessary  to  stop 
it  tight  with  gauze,  but  even  then  the  canula  kept 
its  position  badly.  Stratonoff  used  to  do  the  dress- 
ing. On  removing  it  one  day,  we  found  that  part 
of  the  trachea  had  become  mortified — a  most  un- 
fortunate complication.  Deprived  of  its  support, 
when  introduced  into  the  incision  the  tube  pressed 
against  the  posterior  wall  of  the  windpipe,  and  the 
child  began  to  suffocate.  Stratonoff  placed  the 
canula  in  its  proper  position  and  propped  it  round 
carefully  with  gauze  and  cotton- wool.  The  little 
girl  lay  with  dilated  and  suffering  eyes,  trying  to 
struggle  from  the  nurse's  grasp,  kicking  out  franti- 
cally with  her  legs;  her  face  was  puckered  up  from 
crying,  but  no  sound  could  be  heard:  when  trache- 
otomy is  performed,  the  air  from  the  lungs  escapes 
through  the  canula  without  reaching  the  vocal  cords 


SURGERY— ITS  RISKS  93 

and  the  patient  is  absolutely  dumb.  The  process  of 
dressing  was  very  painful,  but  the  weak  state  of  the 
patient's  heart  forbade  chloroform. 

At  last  Stratonoff  completed  his  task;  the  little 
girl  sat  up;  Stratonoff  scrutinised  her  narrowly. 

"Breathing  is  still  unsatisfactory,"  he  said,  knit- 
ting his  brows,  and  again  began  to  readjust  the 
tube. 

The  child's  face  ceased  to  pucker;  she  sat  still, 
as  if  in  deep  thought,  and  motionlessly  gazed  into 
the  distance,  over  our  heads.  Suddenly  a  strange, 
feeble,  irregular  grating  sound  became  audible.  .  .  . 
The  child  was  grinding  its  teeth  with  convulsively 
set  jaws. 

"Deary  darling,  bear  it  a  little  longer,  it  won't 
hurt  any  more  in  a  minute  I"  said  Stratonoff  in  an 
agonised  voice,  tenderly  stroking  her  cheek. 

But  the  fixed  stare  of  the  poor  mite  never  relaxed 
and  she  continued  to  grind  her  teeth  rapidly;  her 
whole  mouth  grated,  as  if  she  were  crunching  a  piece 
of  sugar;  it  was  a  horrible  sound,  and  my  fancy 
pictured  her  teeth  reduced  to  a  powder  and  her 
mouth  filled  with  a  mass  of  bone-splinters.  .  .  . 

Three  days  later  she  died.  I  swore  never  again 
to  attempt  tracheotomy. 

But  what  did  I  gain  thereby?  My  comirades, 
who  had  commenced  work  sim.ultaneously  with  my- 
self and  who  were  no  less  tender-hearted,  can  now 
save  the  life  of  a  fellow  creature,  where  I  must  stand 


94    THE  MEMOIRS  OF  A  PHYSICIAN 

idly  by,  helpless  to  assist.  About  eighteen  months 
after  my  first  and  last  tracheotomy,  while  I  was  on 
duty,  a  workman  suffering  from  syphilitic  stricture 
of  the  larynx  was  brought  to  our  hospital.  The 
contraction  had  been  gradually  developing  during  a 
whole  month,  and  for  the  last  day  or  two  the  patient 
had  hardly  been  able  to  breathe.  Wasted  and  hag- 
gard, with  his  thin  hair  dishevelled,  and  a  bluish 
earthy  complexion,  he  sat  clutching  his  chest,  breath- 
ing with  a  heavy,  rattling  noise. 

I  sent  for  my  colleague — the  assistant  hous- 
surgeon,  and  ordered  the  patient's  removal  to  the 
operating  room. 

The  surgeon  made  a  rapid  examination. 

"We  shall  have  to  perform  an  operation,  cut  your 
throat  open,"  he  said. 

"All  right,  all  right!  .  .  .  Only  be  quick  about 
it,  for  God's  sake,"  the  patient  muttered  in  deathly 
trouble,  nodding  jerkily. 

While  the  instruments  were  being  prepared,  he 
was  given  oxygen  to  inhale. 

"Now  lie  down!" 

The  patient  crossed  himself  and,  supported  by  the 
assistants,  clambered  on  to  the  operating  table. 
While  we  washed  his  neck,  he  continued  to  inhale 
oxygen.  I  wanted  to  take  away  the  tube,  but  he 
held  on  to  it  supplicatingly. 

"Only  a  little  more,  let  me  breathe  the  'air'  a 
little  longer!"  he  whispered  huskily. 


SURGERY— ITS  RISKS  95 

"You've  had  enough!  You'll  be  easy  in  a  mo- 
ment I"  said  my  comrade.     "Shut  your  eyes." 

The  suffering  man  once  more  crossed  himself  and 
closed  his  eyes  tightly. 

The  operation  was  performed  under  cocaine. 
After  one  or  two  incisions,  I  parted  the  edges  of  the 
wound  with  my  hook-retractors,  the  surgeon  opened 
the  cricoid  cartilage  and  fragments  of  bloody 
phlegm  flew  out  of  the  slit  with  the  usual  fit  of 
coughing.  My  comrade  introduced  the  canula  and 
bound  the  wound  up. 

"It's  all  over!"  he  announced.  The  patient  got 
up,  taking  greedy  and  deep  breaths;  his  face  ex- 
panded into  an  endlessly  happy  and  perplexed 
smile,  and  he  shook  his  head  with  astonishment. 

"Eh,  haven't  we  fixed  you  up  smartly,  my 
friend^"  laughed  the  surgeon.  All  around  were 
laughing,  the  nurses,  Sisters  of  Mercy,  the  attend- 
ants. ... 

In  the  meanwhile  the  patient,  smiling  as  before, 
in  happy  bewilderment,  whispered  something  in- 
audible and  kept  on  shaking  his  head,  lost  in  admi- 
ration for  the  wonderful  resources  of  our  science. 

Next  day  I  visited  the  ward  where  he  lay,  to 
see  how  he  was  getting  on.  He  greeted  me  with 
the  same  silly  and  pleased  grin. 

"How  goes  it?"  I  asked. 

He  nodded  his  head  and  made  a  comprehensive 
gesture,  to  show  how  comfortable  he  felt.  .  .  . 


96    THE  MEMOIRS  OF  A  PHYSICIAN 

I  went  away  with  a  heavy  heart :  I  could  not  have 
saved  him.  If  my  colleague  had  not  been  at  hand, 
that  man  must  have  perished. 

No,  all  my  oaths  were  nonsensical !  It  Could  not 
be  helped!  What  Billroth  said  was  true:  "our 
progress  is  over  mountains  of  corpses."  There  was 
no  other  way.  We  had  to  study  on,  undeterred  by 
failure.  .  .  .  But  that  grinding  of  the  little  girl's 
teeth  resounded  in  my  ears — and  I  felt,  with  de- 
spair, that  I  could  not,  I  could  not;  that  my  hand 
would  never  again  be  lifted  for  such  another  opera- 
tion. 

By  what  should  one  be  guided  under  the  circum- 
stances? Because  I  had  run  away,  it  did  not  mean 
that  the  problem  had  been  solved.  Personally,  I 
might  choose  such  a  course,  but  what  if  all  were  to 
follow  suit?     A  certain  old  doctor,  who  was  chief 

of  the  surgical  division  of  the  Hospital  of , 

used  to  tell  me  of  the  pangs  he  suffered  when  allow- 
ing a  young  doctor  to  operate.  "Of  course,  I  can't 
forbid  it — they  too  must  learn;  but  how  can  I  tran- 
quilly look  on,  expecting  every  moment  to  see  him 
blunder  in  the  most  damnable  way  with  his  knife?" 

And  he  used  to  take  away  his  junior's  knife  and 
complete  the  operation  himself. 

Of  course,  this  sort  of  thing  is  very  conscientious, 
but  .  .  .  but  from  others,  from  doctors  who  had 
been  under  him,  I  heard  that  it  was  not  worth  while 
working  in  my  friend's  division:  he  was  a  good 


SURGERY— ITS  RISKS  97 

surgeon  certainly,  but  it  was  impossible  to  learn 
anything  of  him.  There  is  nothing  strange  in  this. 
A  surgeon  who  is  so  careful  of  his  patients  cannot 
be  a  good  teacher.  Here  is  another  illustration  of 
the  fact.  A  certain  Russian  doctor  and  traveller 
relates  his  impressions  of  the  great  Lister,  the  in- 
ventor of  the  antiseptic  method:  "Lister  takes  the 
interests  of  his  patients  too  near  to  heart  and  places 
his  moral  responsibility  in  regard  to  each  of  those 
upon  whom  he  operates  too  high.  Lister,  accord- 
ingly, rarely  trusts  his  assistants  with  the  binding 
of  arteries  and,  as  a  rule,  he  performs  personally  all 
that  is  connected  with  the  direct  treatment  of  his 
patients.  Thanks  to  this,  his  junior  assistants  lack 
operative  skill."  If  the  individual  interests  of  each 
patient  are  to  be  held  paramount,  of  course  this  is 
the  only  way  to  treat  the  matter.  The  same  trav- 
eller— Professor  A.  S.  Tauber,  in  giving  his  impres- 
sions of  the  German  clinics,  remarks: — 

"A  great  difference  is  noticeable  in  the  subsequent 
progress  of  the  wounds,  when  amputation  has  been 
performed  by  the  experienced  hand  of  the  professor 
and  when  by  his  young  assistants — the  latter  often 
bruise  the  tissues,  crush  the  nerves,  sever  the  muscles 
too  short  off  or  else  lay  the  arterial  vessels  bare  of 
their  adventitiae  (external  coat  of  the  artery)  too 
high, — all  of  which  steps  prevent  rapid  healing  of 
the  stump." 

But  is  it  necessary  to  cite  further  proofs  of  such 


98     THE  MEMOIRS  OF  A  PHYSICIAN 

an  obvious  truth  as  that,  which  tells  us  that  with- 
out experience  it  is  impossible  to  become  a  skilled 
operator^  How  remedy  such  a  situation?  From 
the  doctor's  point  of  view,  it  may  be  possible  to 
resign  oneself  to  the  inevitable^  with  the  reflection, 
that  "such  is  fate — there  is  no  alternative!"  But 
when  I  think  of  the  patient  about  to  submit  himself 
to  the  knife  of  the  surgical  novice,  on  the  point  of 
performing  his  first  operation,  I  find  that  such  argu- 
ments cease  to  satisfy  me,  I  am  conscious  that  there 
must  be  another  way  out  of  the  labyrinth,  which 
ought  to  be  discovered  at  any  cost. 

In  the  late  "thirties"  such  a  way  out  of  the  diffi- 
culty was  proposed  by  the  eminent  French  physiolo- 
gist Magendie.  The  latter  was  of  the  opinion  that 
a  good  surgeon  of  the  anatomical  theatre  was  not 
necessarily  a  good  operator.  Until  he  had  acquired 
the  faculty  of  operating  with  confidence  he  might 
expect  at  any  moment  to  make  the  grossest  mistakes ; 
and  yet,  although  it  ought  to  have  been  there  from 
the  very  beginning,  if  only  the  surgeon's  education 
had  been  better  directed,  that  faculty  could  only  be 
attained  through  long  practice.  The  chief  fault 
lay  with  the  contemporary  methods  of  teaching, 
prevailing  in  the  medical  schools.  The  students 
passed  directly  from  dead  nature  to  the  living,  and 
were  compelled  to  gain  experience  at  the  expense  of 
humanity,  at  the  cost  of  the  lives  of  their  fellow- 
creatures.     Apart  from  man,  there  were  creatures, 


SURGERY— ITS  RISKS  99 

whose  lives  were  less  precious,  and  upon  which  it 
were  permissible  to  perform  initial  experiments. 
Magendie  expressed  the  wish,  that  in  addition  to 
the  usual  medical  education,  skill  in  operating  upon 
living  animals  should  be  required  of  all  physicians; 
for  he  who  had  familiarised  himself  with  the  above 
kind  of  operation,  could  afford  to  laugh  at  those 
difficulties  which  baffled  so  many  surgeons  of  the 
day. 

There  is  nothing  to  prevent  Magendie' s  advice 
being  followed;  nevertheless,  so  far,  it  has  not  been 
put  into  practice.  When  inventing  some  new  op- 
eration, the  surgeon  generally  performs  it  on  ani- 
mals first.  But  so  far  as  my  knowledge  goes, 
nowhere  in  the  world  is  experience  in  operating  on 
living  animals  held  as  a  necessary  qualification, 
previous  to  the  young  surgeon  being  allowed  to 
operate  on  living  man.  As  things  now  stand,  our 
surgical  novices  are  even  inexpert  in  operating  on 
the  dead — let  alone  the  living  body. 

In  the  "thirties,"  the  surgeon  who  studied  anat- 
omy invited  derision.  This  is  what  Diffenbach,  a 
German  professor  of  surgery,  said  of  the  young 
French  surgeon  Velpeau:  "He  is  a  kind  of 
anatomical  surgeon."  "In  Diffenbach's  opinion," 
remarks  Pirogoff,  "that  was  the  worst  possible  re- 
commendation for  a  surgeon." 

So  much  for  the  "thirties" ;  but  let  me  quote  once 
more  from  Prof.  A.  S.  Tauber,  whom  I  have  al- 


lOo    THE  MEMOIRS  OF  A  PHYSICIAN 

ready  had  occasion  to  mention.  Speaking  of  mod- 
ern surgery,  he  says:  "In  Germany,  it  is  usual  for 
the  junior  assistants  in  surgical  clinics  to  learn 
upon  the  living,  not  upon  the  dead.  No  one  will 
dispute  that  the  warm  blood  flowing  beneath  the 
strokes  of  the  knife,  or  the  contractions  of  the  living 
muscles  during  operations,  develop  in  the  young 
surgeon  intrepidity,  presence  of  mind  and  confi- 
dence, but,  on  the  other  hand,  I  believe  that  there 
can  be  no  doubt,  that  such  practising  of  the  inex- 
perienced hand  in  operations  upon  living  man  is 
inhumane  and  generally  at  variance  with  the  aims 
of  the  physician." 

It  appears  to  me  that  only  the  most  strict  and 
systematic  application  of  the  rule  recommended  by 
Magendie  would  save  the  patient — to  a  certain  de- 
gree at  least — from  the  necessity  of  paying  with 
his  blood,  and  even  with  his  life,  for  the  education 
of  skilled  surgeons, — but  not  entirely.  For  how 
determine  the  precise  moment  when  a  surgeon  has 
become  sufficiently  expert?     Where  draw  the  line? 

In  1873  when  in  his  prime  and  at  the  apogee  of 
his  fame,  Billroth  wrote  to  one  of  his  old  friends,  a 
lady,  thus:  "I  have  many  patients  whom  I  have 
operated  upon  and  still  more  upon  whom  it  will 
be  necessary  to  do  so;  they  occupy  all  my  thoughts 
year  by  year,  their  numbers  increase,  and  the  burden 
grows  heavier  and  heavier.  An  hour  ago  I  left  the 
side  of  an  excellent  woman  upon  whom  I  had  op- 


SURGERY— ITS  RISKS  loi 

erated  yesterday — a  terrible  operation.  .  .  .  With 
what  a  look  did  she  gaze  upon  me  this  evening! 
*Will  I  live?'  I  hope  that  she  will  live,  but  our 
art  is  so  imperfect !  I  wish  I  had  a  century  of  ever- 
increasing  knowledge  and  experience  behind  me, — 
perhaps  then  I  might  accomplish  something.  But 
as  things  are  now — our  progress  moves  rather  slowly 
and  it  is  so  difficult  to  transmit  to  another  that  little 
which  one  has  attained  oneself  I  The  one  that 
receives  must  accomplish  the  most  important  him- 
self." 

Surgery  is  an  art,  and  as  such,  demands,  above 
all  else,  creative  power,  and  reconciles  itself  least  of 
all  to  cut  and  dried  standards.  Where  standards 
exist  there  are  no  mistakes,  where  creative  power 
comes  into  play — errors  are  possible  at  every  mo- 
ment. A  long  apprenticeship  of  such  mistakes  and 
false  strokes  evolves  the  master,  and  as  before,  his 
road  lies  over  "Mountains  of  corpses."  .  .  . 

While  still  a  young  "docent"  (lecturer)  of  sur- 
gery, the  sam^e  Billroth  wrote  to  his  master  Baum 
about  a  certain  patient,  whom  he  had  subjected  to 
forcible  extension  of  the  leg  three  times  in  the  course 
of  the  same  week,  without  suspecting  that  the 
capitulum  of  the  tibia  was  broken.  "The  effect  of 
the  extension  upon  the  inflamed  parts  naturally 
turned  out  extremely  harmful;  mortification  super- 
vened, followed  by  death.  .  .  .  That  case  was  very 
instructive  to  me  because,  like  many  others,  it  taught 


102     THE  MEMOIRS  OF  A  PHYSICIAN 

me  what  not  to  do.  But  of  course,  this  is  entre 
nous" 

The  English  surgeon,  Sir  James  Paget,  Bart., 
tells  us  of  a  like  case  in  his  own  practice:  "A 
young  man  had  a  tumour  removed  from  deep  in  the 
back  of  his  thigh,  and  at  the  end  of  the  operation 
I  know  not  whether  by  myself  or  some  one  else,  a 
broad  strip  of  plaster  was  put  round  the  thigh  com- 
pletely encircling  it,  and  over  that  for  some  further 
means  of  security,  a  bandage.  Next  day  the  limb 
was  swollen,  but  apparently  not  much  more  than  it 
might  have  been  swollen  from  ordinary  inflamma- 
tion following  an  operation.  But  the  day  after  the 
limb  was  swollen  much  more;  and  the  day  after 
that,  there  was  acute  inflammation  of  all  cellular 
tissue  about  the  wound;  and  then  came  haemorrhage; 
and  then  the  man  sank  and  died.  The  sole  cause  of 
his  death  was  the  strip  of  plaster  which  was  put 
round  his  limb  and  not  removed  for  two  days. 
From  that  time  to  this  I  think  no  one  ever  saw  me 
put  a  strip  of  plaster  round  a  limb  unless  spirally. 
Small  as  such  a  thing  may  seem  in  the  act  of  dress- 
ing, it  cost  that  man  his  life."  ^ 

A  vivid  picture  of  the  process  necessary  for  the 
development  of  experience  is  given  by  Pirogoff  in 
his  "Annals  of  the  Dorpath  Surgical  Clinic,"  which 
were  published  in  German  towards  the  close  of  the 

^  See   "Clinical  Lectures  and   Essays" :  "Calamities  in  Surgery" 
(Clinical  lecture^  1868;  chapter  ii.  p.  51). 


SURGERY— ITS  RISKS  103 

"thirties"  and  in  their  day  caused  a  great  sensation. 
With  the  frankness  of  genius  he  recounts  in  these 
confessions  of  a  practical  surgeon,  all  the  mistakes 
and  miscarriages  for  which  he  was  responsible,  while 
in  charge  of  the  University  Hospital. 

That,  which  others  only  venture  to  mention  in 
private  letters  entre  nous^  was  published  in  the  face 
of  the  whole  world  to  the  great  confusion  and 
scandal  of  all.  The  lurid  picture  painted  by  him 
was  shocking  in  the  extreme. 

Yes,  once  more,  all  this  is  entirely  unavoidable; 
.there  is  no  other  way.  Things  will  have  to  remain 
as  they  are :  the  torments  of  conscience  must  become 
silent  in  the  presence  of  the  inevitable.  And,  never- 
theless, I  myself  would  on  no  account,  of  my  own 
free  will,  consent  to  become  the  victim  of  that  in- 
evitability, nor  has  any  victim  ever  wished  to  repeat 
his  experience. 

Countless  is  the  number  of  such  cursed  problems 
in  this  terrible  science  of  ours,  in  the  pursuit  of 
which  it  is  impossible  to  step  without  stumbling 
against  living  man  I 


CHAPTER  VII 

IN    MEDICINE NOTHING    RISKED    NOTHING    GAINED 

IN  1888  Professor  Petrescu  of  Bucharest  proposed 
that  croupous  pneumonia  should  be  treated  with 
very  large  doses  of  digitalis  (tenfold  of  that  cus- 
tomary). According  to  his  observations,  which  ex- 
tended over  a  number  of  years,  when  this  treatment 
was  employed  the  death-rate  dropped  from.  20-30% 
to  3%,  the  disease  was  arrested  instantly  and  van- 
ished "as  at  the  wave  of  the  magician's  wand." 
Petrescu's  paper  on  his  treatment,  read  before  the 
Parisian  Academy  of  Medicine,  attracted  general 
attention — the  results  published  were  really  most 
striking.  Other  doctors  adapted  it  and  in  most 
cases  were  very  pleased  with  the  results  obtained. 

At  that  time  I  had  the  pneumonia  ward  of  our 
Infirmary  under  my  care.  Fascinated  by  the  above 
communications,  I  decided,  with  the  permission  of 
the  chief  house-physician,  to  try  Petrescu's  method. 
Only  a  little  while  before  I  had  read  an  article, 
which  appeared  in  Botkin's  Hospital  Gazette^  by 
Dr.  Rechtsamer,  dealing  on  the  subject.  Although 
the  author  regarded  Petrescu's  hopes  as  somewhat 

exaggerated,  still  he  did  not  deny  that  the  recovery 

104 


MEDICINE  MUST  RISK  TO  GAIN     105 

of  certain  of  his  patients  could  only  be  ascribed  to 
the  new  treatment.  In  his  opinion,  it  was  recom- 
mendable  as  a  last  remedy  in  grave  cases  affecting 
old  people  and  drunkards.  'In  none  of  my  own 
cases  could  I  put  a  patient's  death  down  to  digitalis 
poisoning,"  so  the  article  ended. 

An  old  house-plasterer,  who  had  been  suffering 
from  pneumonia  for  two  days,  was  brought  to  my 
ward;  his  entire  right  lung  was  involved  through 
and  through,  he  breathed  rapidly,  groaned  and 
tpssed  about;  his  wife  told  me  that  he  had  been  a 
Kird  drinker  from  childhood.  This  was  a  suitable 
case  and  I  prescribed  digitalis  according  to  Petrescu. 

In  the  act  of  signing  my  prescription  I  paused, 
involuntarily  struck  by  its  extraordinary  appear- 
ance.    It  ran  thus: — 

"RP  Inf.  fol.  Digitalis  ex  8.0  ( !)  :  200.0 
D.S.  every  hour  (!)  a  tablespoonful." 

This  means  a  decoction  of  eight  grammes  of  digi- 
talis in  two  hundred  grammes  of  water,  while  the 
notes  of  exclamation  were  required  by  law  for  the  ^ 
benefit  of  the  dispenser:  in  common  practice, 
the  greatest  quantity  of  digitalis  leaf,  which  may 
be  administered  to  the  human  being  in  the  course  of 
the  twenty-four  hours,  is  put  down  at  0.6  grammes ; 
those  notes  of  exclamation  showed  the  chemist,  that 
in  prescribing  my  monstrous  dose,  I  had  not  been 
guilty  of  a  clerical  error,  but  acted  quite  consciously. 


i66     THE  MEMOIRS  OF  A  PHYSICIAN 

I  perused  my  prescription  again  and  again.  Those 
notes  of  exclamation  stared  at  me  provokingly,  al- 
most insolently,  as  if  saying:  "Yes,  you  dare  not 
give  a  man  more  than  six  decimals  of  digitalis  un- 
less to  poison  him  be  your  intent,  while  you  order 
thirteen  times  that  amount!" 

When  I  left  the  hospital  the  notes  of  exclamation 
in  my  prescription  still  haunted  me.  I  recalled  Dr. 
Rechtsamer's  words:  "In  none  of  my  cases  could 
I  put  a  patient's  death  down  to  digitalis  poisoning;" 
but  what  would  I  do,  if  the  sad  necessity  of  "putting 
a  patient's  death  down  to  digitalis  poisoning,"  were 
reserved  for  me"?  Had  I  not  dashed  off  those  elo- 
quent notes  of  exclamation  with  my  own  hand"? 

Next  day  the  patient  v/as  worse;  he  stared  at  me 
dully  with  glassy  eyes,  the  tip  of  his  nose  had  as- 
sumed a  bluish  tinge,  his  pulse,  continuing  rapid, 
was  fluctuating  now.  Was  this  in  consequence  of, 
or  notwithstanding  the  digitalis^  The  patient's 
heart  was  weak  and  these  phenomena  might  be  as- 
cribed to  the  course  of  the  disease,  which  the  digitalis 
had  been  powerless  to  stem.  But,  on  the  other 
hand — what  if  this  were  owing  to  the  drug?  I  did 
my  best  to  suppress  such  reflections :  why,  many  had 
tested  the  remedy  and  found  it  to  be  efficacious 
and  beneficial.     So  I  renewed  my  prescription. 

Two  days  later  the  old  man  died.  The  weakness 
of  the  heart  had  ever  been  on  the  increase,  accom- 
panied towards  the  end  by  deafness.     I  stumbled 


MEDICINE  MUST  RISK  TO  GAIN     107 

up  against  his  wife  at  the  gates  of  the  hospital;  she 
was  in  the  act  of  leaving  the  mortuary  chapel,  mum- 
bling to  herself,  her  face  and  swollen  eyes  almost 
hidden  by  her  shawl.  With  an  indefinable  sensa- 
tion of  shame  and  fear  I  read  the  deceased's  clinical 
register  over  again:  a  minute  description  of  his  ill- 
ness continued  from  day  to  day,  showing  its  gradual 
aggravation,  the  prescriptions  with  their  glaring 
notes  of  exclamation,  and  in  conclusion — a  laconic 
footnote  by  the  doctor  on  duty:  "The  patient  died 
at  2  A.M." 

Now  I  was  at  a  loss  to  account  for  the  mental 
aberration  which  had  prompted  me  to  prescribe  such 
bold  and  unverified  treatment.  Possibly  the  old 
man  would  have  died  in  any  case,  but  could  I  under- 
take to  affirm  that  his  death  had  not  been  caused 
by  that  monstrous  amount  of  powerfully  acting 
digitalis,  introduced  by  me  into  his  system  *?  And 
at  a  time,  too,  when  all  the  forces  of  his  organism 
were  required  for  combating  his  disease. 

Soon  afterwards  I  read  an  article  in  the  'Physician 
by  Dr.  Rubel,  who,  after  carefully  studying  his  own 
experiments,  those  of  Petrescu  and  of  the  latter's 
disciples  and  partisans,  proved  irrefutably  that 
"Petrescu's  treatment  is  obviously  injurious  and  in 
many  cases  threatens  the  patient's  life;  it  only  re- 
mains to  advise  its  complete  discontinuation." 

And  I  registered  a  vow  in  future  only  to  employ 
those  remedies  upon  my  patients,  which  had  stood 


id8     THE  MEMOIRS  OF  A  PHYSICIAN 

ample  test  and  left  no  room  for  doubt  as  to  their 
effects.  The  closer  I  became  acquainted  with  cur- 
rent medical  literature,  the  firmer  did  this  decision 
become.  An  appalling  state  of  affairs  was  revealed 
to  me.  Each  number  of  every  medical  journal 
contained  communications  on  dozens  of  new  reme- 
dies; and  thus  it  went  on,  from  week  to  week,  from 
month  to  month;  a  gigantic,  insane  and  endless  tor- 
rent, which  bewildered  the  eyes:  new  doses,  new 
medicines,  new  methods  of  introducing  them,  new 
operations — and  dozens,  nay — ^hundreds  of  human 
lives  lost  and  healths  ruined.  Some  of  these  inno- 
vations, like  bubbles  on  the  frothing  surface  of  a 
torrent,  leaped  up  and  immediately  burst,  leaving 
behind  one  or  two  corpses. 

Thus,  for  instance,  in  1888  Dr.  Rosenbusch  pub- 
lished an  article  in  which  he  advocated  the  injection 
of  a  solution  of  creosote  into  the  lung  tissue  of  con- 
sumptives, which,  according  to  his  assurances,  gave 
the  best  results.  Dr.  Stakhewicz  tried  to  apply  this 
method  of  treatment  upon  two  of  his  patients;  the 
results  speak  for  themselves:  "The  cough  of  the 
first  patient  increased  after  the  injection,  and  the 
destruction  of  the  left  apex,  into  which  the  injection 
had  been  made,  proceeded  with  much  greater  rapidity 
than  before.  Blood  appeared  in  the  sputum  of  the 
other  patient  immediately  after  the  injection  and 
next  day  an  abundant  hsemorrhage  supervened." 
And  creosote  injections  disappeared  from  the  stage. 


MEDICINE  MUST  RISK  TO  GAIN     109 

Professor  Mehring  caused  animals  to  inhale 
pental  and  arrived  at  the  conviction  that  it  would 
be  a  very  good  anaesthetic.  This  was  followed  by 
Dr.  Hollaender  experimenting  upon  his  patients 
with  the  drug,  and  he  obtained  brilliant  results  with 
it.  At  the  Congress  of  Naturalists  and  Physicians, 
held  at  Halle  during  September,  1891,  he  expressed 
himself  rapturously  in  favour  of  pental.  He  de- 
clared that  it  had  proved  itself  to  be  the  best  extant 
anesthetic  for  short  operations,  thanks  to  the  cer- 
tainty of  its  action,  the  absence  of  disagreeable 
after-effects  for  the  patient,  and  its  entire  freedom 
from  danger;  pental  had  no  ill-effects  either  upon 
the  cardial  functions  or  those  of  respiration.  So 
pental  became  the  fashion.  Six  months  passed. 
Then  Dr.  Haegler  made  the  following  communica- 
tion: a  strong  man,  to  whom  he  had  administered 
the  anaesthetic,  developed  dyspnoea  and  cyanosis, 
which  were  finally  succeeded  by  cessation  of  respira- 
tion; only  the  most  energetic  means  of  revival  saved 
his  life.  Two  months  more  passed,  and  a  lady  died 
at  Olmiitz,  after  inhaling  pental  while  having  a 
tooth  drawn.  About  the  same  time  tlie  British 
Journal  of  Dentistry  published  the  following  fact: 
a  young  woman  of  thirty-three,  suffering  from  tooth- 
ache, died  after  inhaling  ten  drops  of  the  drug. 
Dr.  Breier  nearly  lost  a  healthy  little  girl,  whose 
respiration  and  pulse  ceased  through  inhaling  pental. 
Two  of  Dr.  Sick's  patients  died  from  its  effects — 


110     THE  MEMOIRS  OF  A  PHYSICIAN 

one  a  strong  and  vigorous  man,  the  other  a  young 
girl  suffering  from  hip-disease,  but  otherwise  sound 
and  healthy.  Hardly  a  year  and  a  half  had  elapsed 
since  Hollaender's  first  communication  saw  the  light, 
when  Professor  Gurlt  read  a  paper  at  a  congress  of 
German  surgeons,  in  which  he  gave  comparative 
statistics  of  the  mortality  from  different  ansesthetics. 
Supported  by  overwhelming  statistical  evidence,  he 
showed  that  while  ether,  laughing-gas,  brom.  aetyl 
and  chloroform  produced  one  death  in  thousands, 
pental  gave  one  death  for  each  igg  cases.  Profes- 
sor Gurlt  concluded  his  report  with  the  very  sen- 
sible remark,  that  in  view  of  the  data  so  far  obtained 
it  became  necessary  positively  to  warn  the  faculty 
against  the  employment  of  pental.  And  the  ill- 
omened  compound  vanished  as  swiftly  as  it  had  ap- 
peared. 

Has  any  one  forgotten  the  triumphal  flourish  of 
trumpets  which  announced  the  advent  of  Koch's 
tuberculine,  and  its  unfortunate  exit^  Thousands 
of  tuberculous  patients  were  injected  with  the  cele- 
brated lymph  at  the  time.  While  two  years  later, 
it  became  clear  beyond  doubt  that  nothing  but  mis- 
chief could  result  from  its  use.^ 

Such  is  the  history  of  a  few  of  those  new  remedies 
which  have,  upon  closer  acquaintance,  proved  them- 
selves to  be  worthless.     However,  the  fate  of  others 

^  The  failure  of  Koch's  tuberculine  was  due  to  ill-judged  em- 
ployment in  unskilled  hands. 


MEDICINE  MUST  RISK  TO  GAIN     in 

was  very  different:  they  emerged  from  trial,  their 
position  assured  and  recognised  by  all,  with  their 
indications  and  counter-indications  strictly  defined. 
But  even  then,  a  heavy  toll  in  human  life  and  health 
had  to  be  paid. 

A  peculiar  illness  is  frequently  met  with  amongst 
the  inhabitants  of  mountainous  districts — goitre 
(struma),  when  the  thyroid  gland,  located  about  the 
lower  part  of  the  throat,  becomes  enlarged.  One  of 
the  methods  for  treating  goitre  was  the  complete 
eradication  of  the  organ.  This  operation  gave  very 
encouraging  results :  the  patients  left  hospital  in  per- 
fect health  and  their  deprivation  of  the  thyroid 
gland  seemingly  had  no  evil  effects.  But  in  1883 
Professor  Kocher  of  Berne  published  an  article  in 
which  he  communicated  the  following:  he  had  per- 
formed complete  extirpation  for  struma  in  thirty- 
four  cases  and  was  very  pleased  with  the  results  ob- 
tained. But  one  day  a  medical  friend  told  the 
Professor  of  a  girl  under  his  treatment,  upon  whom 
Kocher  had  performed  the  above-mentioned  opera- 
tion nine  years  previously,  and  advised  the  eminent 
surgeon  to  examine  her  now.  The  tableau  was  a 
striking  one.  The  patient  had  a  younger  sister ;  nine 
years  before  both  were  so  much  alike  that  they  were 
often  mistaken  for  each  other.  "In  the  course  of 
those  nine  years,"  Kocher  tells  us,  "the  younger  sis- 
ter developed  into  a  blooming  and  pretty  girl;  the 
one  operated  upon  remained  stunted  and  has  the 


112     THE  MEMOIRS  OF  A  PHYSICIAN 

repulsive  appearance  of  a  semi-idiot."  Such  a  reve- 
lation prompted  Kocher  to  enquire  into  the  fate  of 
all  those  he  had  operated  upon  for  this  peculiar  dis- 
ease. In  the  case  of  the  twent)^-eight  patients  who 
had  undergone  but  partial  removal  of  the  thyroid 
gland,  all  were  found  to  be  quite  healthy;  of  the 
eighteen  who  had  been  entirely  deprived  of  that 
organ,  only  two  remained  in  health;  the  rest  had 
developed  a  peculiar  complexity  of  symptoms,  thus 
characterised  by  Kocher:  "the  retention  of  growth, 
the  large  head,  knobby  nose,  thick  lips,  clumsy  body, 
unwieldiness  of  tongue  and  thought,  accompanied 
by  excessive  muscular  development — all  these  un- 
doubtedly point  to  the  close  relationship  of  the  de- 
scribed disease  to  idiocy  and  cretinism."  Mark  you, 
the  growth  caused  but  little  inconvenience  to  many 
of  those  operated  upon,  and  practically,  the  opera- 
tion merely  had  the  sesthetic  in  view ;  the  result,  how- 
ever, was  idiocy.^  Later  the  close  connection  be- 
tween the  above  symptoms  and  the  removal  of  the 
thyroid  gland — the  opinion  held  by  Professor 
Kocher — was  disputed;  but,  nevertheless,  nowadays 
no  surgeon  would  ever  venture  to  perform  complete 
extirpation,  unless  the  disease  of  the  gland  threat- 
ened the  patient  with  unavoidable  death. 

In  1884,  Koller  introduced  into  general  use  one 
of  the  most  precious  remedies  which  medicine  pos- 

^  The  failure  of  the  operation  for  the  complete  removal  of  the 
thyroid  was  due  to  the  fact  that  the  para  thyroid  glands  were  also 
removed. 


MEDICINE  MUST  RISK  TO  GAIN     113 

sesses — cocaine — ideal  for  local  ansesthesia.  Two 
years  later,  Professor  Kolomnin  of  St.  Petersburg, 
while  about  to  operate  upon  a  woman,  introduced 
into  her  rectum  a  solution  of  the  alkaloid.  Sud- 
denly the  patient  went  blue  in  the  face,  convulsions 
seized  her,  and  half  an  hour  afterwards  she  expired 
with  all  the  symptoms  of  cocaine-poisoning.  Profes- 
sor Kolomnin  went  home,  locked  himself  up  in  his 
study  and  blew  out  his  brains. 

In  the  reperusal  at  the  present  day  of  the  different 
communications  made  on  the  employment  of  cocaine 
during  the  first  few  years  after  its  introduction,  one 
is  struck  by  the  excessiveness  of  the  doses  prescribed : 
for  example.  Professor  Kolomnin  introduced  about  a 
gramme  and  a  half  of  the  drug  into  his  patient's 
system,  and  such  doses  were  not  exceptional  in  those 
days;  Huseman  considered  that  the  fatal  dose  for 
an  adult  must  be  "very  large."  The  bitter  experi- 
ence of  Kolomnin,  as  well  as  others,  has  taught  us 
that,  on  the  contrary,  the  amount  necessary  is  very 
small;  that  it  is  dangerous  to  introduce  more  than 
six-hundredths  of  a  gramme  of  the  alkaloid  into  the 
human  body;  which  quantity  is  twenty- five  times 
less  than  what  the  unfortunate  Kolomnin  admin- 
istered to  his  patient. 

Towards  the  close  of  the  "eighties,"  Professor 
Kast  introduced  sulphonal  as  an  excellent  and  harm- 
less soporific.  Other  doctors  began  to  experiment 
with  the  drug  and  found  it  was  really  a  * 'harmless 


114     THE  MEMOIRS  OF  A  PHYSICIAN 

hypnotic  which  does  not  evoke  any  accessory  ef- 
fects" (Oestreicher).  But  barely  three  months 
after  the  appearance  of  Professor  Kast's  article,  Dr. 
Schmei  informed  the  medical  world  that  two 
grammes,  given  to  an  old  man  suffering  from  arterio- 
sclerosis and  subject  to  fits  of  angina  pectoris,  "were 
terrible  in  their  effect :  shortly  after  taking  the  pow- 
der a  most  acute  attack  of  suffocation  set  in  and 
all  night  long  these  attacks  followed  each  other  at 
intervals  of  a  few  minutes."  Dr.  Schmei  accord- 
ingly counselled  circumspection,  when  prescribing 
sulphonal  in  cases  of  angina  pectoris  and  arterio- 
sclerosis. Further  observations  showed  that  it 
should  be  administered  with  great  precautions  in 
cases  of  extreme  ansemia,  emphysema  of  the  lungs, 
acute  melancholia  and  morphinism;  and  furttier, 
that  it  is  not  safe  to  take  it  for  a  lengthened  period 
without  break. 

What  was  the  price  paid  for  this  information? 
In  the  course  of  five  years  following  the  first  in- 
troduction of  the  drug,  Professor  Lcpine  aggre- 
gated the  total  number  of  fatal  cases  of  sulphonal 
poisoning,  which  appeared  in  the  medical  press,  at 
sixteen.  .  .  . 

Yes,  ccrtaiftly  the  deduction  to  be  drawn  from  the 
above  was  obvious  enough.  I  was  never  to  employ 
a  remedy  which  had  not  been  thoroughly  tested  be- 
forehand, or  threatened  my  patient  with  the  slightest 
risk. 


MEDICINE  MUST  RISK  TO  GAIN     115 

About  three  years  ago,  I  attended  a  certain  lady 
school-teacher  suffering  from  phthisis.  Just  then 
the  news  arrived  that  Robert  Koch,  who  had  con- 
tinued to  work  upon  his  discredited  tuberculine,  had 
improved  and  was  once  more  employing  it.  My 
patient  consulted  me  as  to  the  advisability  of  her 
subjecting  herself  to  treatment  with  the  "purified" 
lymph. 

"Better  wait  a  bit,"  I  answered.  "First  let  the 
superiority  of  the  new  stuff  over  the  old  be  es- 
tablished!" 

I  had  acted  quite  conscientiously,  but  could  not 
help  wondering  at  whose  cost  would  the  right  answer 
be  arrived  at*?  Somewhere^  far  away  and  beyond 
my  ken,  the  matter  would  be  threshed  out  by  ex- 
perim^ent  upon  the  invalid,  and  if  it  proved  a  suc- 
cess .  .  .  why,  I  would  avail  myself  of  the  result 
and  apply  the  new  treatment  to  my  own  patients,  as 
I  now  employed  such  invaluable  remedies  as  sul- 
phonal  and  cocaine.  But  again,  what  would  hap- 
pen if  all  doctors  regarded  matters  in  the  same  way 
as  myself? 

We  still  know  very  little  of  the  human  organism 
and  of  the  laws  which  govern  it.  In  making  use  of 
a  new  medicament,  the  physician  can  only  foretell  its 
action  more  or  less  approximately.  It  may  turn  out 
beneficial ;  however,  even  if  it  were  to  work  nothing 
but  harm,  astonishment  would  be  out  of  place;  the 
game  being  played  in  the  dark,  it  stands  to  reason 


ii6    THE  MEMOIRS  OF  A  PHYSICIAN 

that  one  should  be  prepared  for  all  eventualities. 
The  chances  of  such  surprises  are  limited  to  a  certain 
extent,  thanks  to  the  possibility  of  previously  trying 
the  drugs  on  animals;  this  is  a  great  help.  But, 
nevertheless,  the  organisms  of  animals  differ  greatly 
from  that  of  man,  and  we  cannot  draw  unimpeach- 
able inferences  from  these  experiments.  So  man  is 
approached,  although  it  is  a  secret  to  no  one  that 
the  remedy's  efficacy — beneficial  or  the  reverse — is 
but  a  matter  of  pure  conjecture;  a  greater  or  lesser 
risk  is  always  present.  Expectations  may  often  be 
deceived,  and  what  is  more,  in  many  cases  this  does 
not  at  once  become  apparent:  clinical  observation 
is  laborious  and  complicated.  Not  infrequently  the 
action  of  the  compound  misleads  one  for  a  long  time, 
the  favourable  impression  it  created  turning  out 
afterwards  to  have  been  merely  due  to  self-sugges- 
tion on  the  observer's  part. 

Because  medicine  did  not  hesitate  to  follow  this 
path,  wrought  with  constant  risks,  upon  which  it 
was  forced  to  blunder  in  the  dark,  falling  into  error 
over  and  over  again,  and  then  renouncing  its  mis- 
takes, it  gained  most  of  those  victories  in  which  its 
pride  is  fully  justified.  Without  risks  being  taken, 
no  progress  would  have  been  made — the  whole  his- 
tory of  medical  science  stands  to  prove  this. 

During  the  first  half  of  the  nineteenth  century, 
women  were  treated  internally  for  tumour  of  the 
ovarium.     The  experiments  made  for  the  removal 


MEDICINE  MUST  RISK  TO  GAIN     117 

of  these  growths  by  surgical  means- — the  dissection 
of  the  abdomen  (ovariotomy) — ended  so  disas- 
trously, that  if  I  had  been  v/riting  these  confessions 
fifty  years  ago,  I  would  have  adduced  ovariotomy  as 
an  example  of  unpardonable  experiment  upon  the 
human  being.  At  that  time  there  lived  in  England 
a  3^oung  surgeon,  Spencer  Wells  by  name.  He  had 
had  occasion  to  assist  at  ovariotomy,  and  his  im- 
pressions tended  to  show  "that  ovariotomy  was  not 
a  justifiable  operation."  Soon  after,  he  took  part 
in  the  Crimean  War,  in  the  capacity  of  surgeon;  he 
saw  many  wounds  in  the  abdomen  and  had  followed 
many  such  cases.  He  remarks :  "When  I  returned 
to  London  in  1856  I  was  certainly  much  less  afraid 
than  before  of  abdominal  wounds."  He  now  be- 
lieved that  ovariotomy  ought  to  give  good  results, 
if  the  operation  be  properly  carried  out.  At  the 
same  time,  it  was  held  in  such  universal  distrust  that 
in  medical  circles  it  had  been  dubbed  "murderous," 
and  the  Crown  lawyers  openly  declared  that  sur- 
geons guilty  of  it  ought  to  be  prosecuted.  Notwith- 
standing this,  Spencer  Wells  decided  to  chance  the 
risks  as  soon  as  occasion  presented  itself.  He  had 
not  long  to  wait,  and  performed  his  first  ovariotomy. 
The  patient  died.  "I  think,"  wrote  Spencer  Wells, 
"it  would  be  difficult  to  imagine  a  position  more 
disheartening  than  that  in  which  I  was  placed  when 
making  my  trials  of  ovariotomy.  The  first  attempt 
was  a  complete  failure,  and  strengthened  not  only 


ii8     THE  MEMOIRS  OF  A  PHYSICIAN 

in  the  minds  of  others,  but  in  my  own  mind,  the  fear 
that  I  might  be  entering  upon  a  path  which  would 
lead  rather  to  unenviable  notoriety  than  to  a  sound 
professional  reputation.  Everything  was  against 
the  venture.  The  medical  press  had  denounced  the 
operation,  both  in  principle  and  practice,  in  the 
strongest  terms.  At  the  medical  societies,  the 
speakers  of  the  highest  authority  had  condemned  it 
most  emphatically."  Still,  undaunted,  Spencer 
Wells  continued  to  operate,  with  ever-increasing  suc- 
cess. Opinion  began  to  veer  round  little  by  little. 
Finally  in  1864  "ovariotomy  was  very  generally 
accepted  as  a  legitimate  operation  and  was,  not  long 
afterwards,  cited  as  a  triumph  of  modern  surgery." 

It  was  in  the  "eighties"  that  Spencer  Wells  thus 
spoke — covered  with  world-wide  glory,  one  of  the 
benefactors  of  humanity,  thanks  to  whom  the  lives 
of  tens  of  thousands  of  women  had  been  saved. 
Who  will  dare  to  reproach  him  in  his  temerity^ 
No  one  sits  in  judgment  upon  the  conqueror. 

A  few  years  ago,  when  Behring  introduced  his 
anti-diphtherial  serum.  Professor  Pouriege,  in  draw- 
ing attention  to  the  unscientific  way  in  which  his 
experiments  had  been  conducted,  laid  stress  upon 
the  hardihood  required  for  the  injecting  of  children 
with  the  diphtherial  anti-toxin,  without  being  quite 
sure  as  to  the  possible  results. 

However  that  may  have  been,  the  serum  proved 
highly  beneficial    (at  least,   thus  it  would  appear 


MEDICINE  MUST  RISK  TO  GAIN     119 

so  far),  and  we  can  only  be  grateful  to  its  discoverer. 
It  would  enter  no  one's  head  to  enquire  too  closely 
whether  Behring  could  have  nerved  himself  to  use 
his  own  child  for  a  first  experiment. 

When,  in  his  old  age,  Pirogoif  developed  cancer 
of  the  upper  jaw,  Dr.  Vivodtseff,  who  attended  him, 
begged  Billroth  to  operate  upon  the  great  veteran 
of  Russian  surgery.  But  on  mastering  the  circum- 
stances of  the  case,  Billroth  found  that  he  dared 
not  take  the  risks,  "I  am  no  more  the  fearless  and 
bold  operator  you  used  to  know  in  Zurich,"  he  wrote 
to  Vivodtseff.  "Now,  when  an  operation  seems  in- 
dicated, I  always  ask  myself  the  following  question : 
'Would  I  submit  to  the  operation  I  wish  to  perform 
upon  the  patient?'  "  Must  we  infer  that  Billroth 
used  to  perform  operations  on  his  patients  which  he 
would  not  permit  in  his  case'?  Certainly.  Other- 
wise we  would  not  possess  that  series  of  brilliant  new 
operations  which  we  owe  to  him. 

So  to  act  up  to  the  motto,  "only  employ  what 
has  been  tested,"  which  I  had  chosen  for  my  own, 
was  not  so  simple  and  plain  as  had  seemed  at  first 
glance.  As  long  as  I  applied  the  rule  to  myself 
I  found  it  to  answer  admirably  and  to  be  the  only 
admissible  one;  but  when  I  tried  to  imagine  all 
adopting  it,  I  saw  that  such  a  mode  of  action  would 
not  only  lead  to  the  undoing  of  medicine,  but  to  an 
absolute  absurdity.  "You  say,"  wrote  the  French 
surgeon,  Pean,  recently  deceased,  "you  say,  that  it 


120     THE  MEMOIRS  OF  A  PHYSICIAN 

is  only  permissible  to  apply  to  man  remedies  which 
have  been  previously  tried  on  man;  but  such  a  con- 
tention contradicts  itself;  if  medicine  were  to  fol- 
low it,  to  its  misfortune,  it  would  condemn  itself  to 
the  purest  empiricism,  to  the  most  dogmatic  tradi- 
tion. Experiments  upon  animals  would  only  serve 
the  purposes  of  speculative  research;  great  benefit 
would  accrue  to  veterinary  medicine,  of  course, 
through  these  experiments,  but  human  medicine 
would  be  unable  to  utilise  them." 

In  effect,  what  would  medicine  turn  into  then*? 
If  new  untried  remedies  could  be  used,  it  would 
be  impossible  to  renounce  the  methods  already 
tested;  the  doctor  who  did  not  treat  syphilis  with 
mercury  would  be  no  less  in  the  wrong,  according 
to  such  a  standpoint,  than  the  one  who  employed 
some  untried  remedy  for  the  same  disease ;  it  requires 
as  much  courage  to  discard  the  old,  as  to  introduce 
the  new.  At  the  same  time,  the  history  of  medi- 
cine tends  to  show  that  our  science  of  to-day,  not- 
withstanding all  its  positive  acquisitions,  has  been 
enriched — to  use  Magendie's  expression — chiefly 
through  its  losses. 

The  inevitable  result  would  not  be  far  to  seek: 
practical  medicine  would  become  petrified  until  that 
distant  date  when  science  had  attained  to  a  perfect 
understanding  of  the  human  organism,  the  action  of 
each  new  remedy  proposed  being  foreseen  in  all  its 
effects.     But  in  the  meanwhile,  on  every  side  we 


MEDICINE  MUST  RISK  TO  GAIN     121 

hear  humanity  cry :  "Help  us,  why  do  you  not  do 
more  to  help  us?" 

My  position  became  highly  anomalous.  My  as- 
pirations did  not  seem  to  rise  above  the  one  desire — 
not  to  do  the  patient  who  sought  my  aid  any  harm. 
At  first  glance  such  a  rule  would  appear  to  be  quite 
elementary,  requiring  no  further  explanation;  at  the 
same  time,  its  systematic  application  would  condemn 
me  to  complete  inactivity,  render  me  utterly  inca- 
pable. Living  man  obstructs  every  path  I  would 
take.  If  I  were  to  turn  back  I  might  perhaps  pre- 
serve my  peace  of  mind,  but  would  be  no  nearer  the 
truth.     And  it  is  the  same  in  all. 

How  define  the  limits  of  the  permissible'?  I 
leave  some  one  else  to  give  the  answer.  And  it  is 
just  at  the  present  time  that  these  questions  have  be- 
come especially  acute.  The  creation  of  bacteriology 
was  the  crowning  achievement  of  a  great  epoch  of 
capital  discoveries  in  the  province  of  medicine,  and 
a  temporary  lull  has  fallen.  And  as  always  hap- 
pens at  such  times,  empiricism  rears  its  head  and 
practice  is  inundated  with  a  sea  of  all  sorts  of  rem- 
edies. Without  end  and  without  a  pause,  the  most 
varied  new  chemical  substances  are  offered  to  us — 
anesin,  cosaprin,  golocain,  criofin,  midrol,  and  thou- 
sands of  others;  every  thinkable  bacterial  toxin  and 
anti-toxin  is  injected  into  the  patient,  as  well  as 
extracts  from  every  imaginable  animal  organ;  all 
manner  of  operations  are  being  invented — both  san- 


122     THE  MEMOIRS  OF  A  PHYSICIAN 

guinary  and  bloodless.  Perhaps  much  of  value  will 
remain  behind,  when  this  whirlwind  has  passed  over 
us;  but  the  heart  sinks  at  the  thought  of  the  price  it 
will  be  bought  with — and  one  pities  sick  humanity, 
which,  like  a  moth  attracted  by  the  flame,  hurries 
onward  towards  its  own  destruction,  often  against 
the  advice  of  us  doctors. 

One  day,  soon  after  my  arrival  in  St.  Petersburg, 
I  had  occasion  to  visit  an  aged  aunt,  the  widow  of 
a  general  officer.  She  began  to  regale  me  with  an 
account  of  her  numerous  complaints — palpitations, 
heart-burn,  nervous  tics,  insomnia  and  the  like. 

"My  doctor  has  prescribed  a  new  medicine  to  help 
me  to  sleep.  The  very  latest!  I  suppose  you  don't 
know  it  yet.  .  .  .  How  do  they  call  it?  Chlo-ra- 
lose.  .  .  .  Not  hydrate  of  chloral,  that  acts  upon 
the  heart — this  is  quite  harmless;  an  improved 
chloral." 

She  rose  and  fetched  me  a  smart  box  of  tabloids, 
ordered  for  her  by  a  fashionable  physician,  and,  with 
every  sign  of  satisfaction,  showed  me  the  prescrip- 
tion. 

"Poor,  poor  thing  I"  I  thought. 


CHAPTER  VIII 

MEDICINE    AN    ART;    NOT    A    SCIENCE 

ON  the  eve  of  completing  my  studies  at  the  Uni- 
versity I  gloried  in  medicine  and  my  faith  in  it 
was  unbounded.  Its  scientific  acquisitions  were  im- 
mense ;  a  great  deal  of  the  human  organism  had  been 
placed  within  our  reach  and  was  perfectly  under- 
stood ;  in  time  no  mysteries  would  remain  for  us,  and 
the  way  to  the  attainment  of  our  goal  was  sure.  It 
was  with  such  a  perfectly  definite  conception  of 
medicine,  that  I  began  practice.  But  here,  at  the 
outset,  I  stumbled  up  against  living  man,  and  all  my 
preconceived  views  underwent  a  rude  shock.  "We 
do  not  yet  know  the  functions  of  this  organ  .  .  . 
the  action  of  such-and-such  a  remedy  is  not  under- 
stood by  us  yet  .  .  .  the  causes  of  such-and-such  a 
disease  are  unknown" — I  read.  What  did  Science's 
great  conquests  avail,  if  we  were  surrounded  by  such 
immeasurable  horizons,  where  all  was  still  obscure 
and  unexplained?  What  do  I  understand  of  the 
patient's  condition  if  I  do  not  understand  all,  and 
how  am  I  to  approach  him?  The  works  of  a  time- 
piece are  incomparably  more  simple  than  the  human 

123 


124     THE  MEMOIRS  OF  A  PHYSICIAN 

organism,  yet  can  I  undertake  to  repair  a  watch  un- 
less I  am  familiar  with  its  every  part,  down  to  the 
most  insignificant  cog-wheel? 

As  on  my  first  introduction  to  medicine,  I  was 
once  more  struck  by  its  endless  imperfection  of  diag- 
nosis and  the  unreliability  and  precariousness  of  all 
its  indications.  Only  with  this  difference :  formerly 
I  was  filled  with  a  deep  contempt  for  ''those"  who 
had  created  such  a  poor  science;  while  now  its  im- 
perfections stood  out  before  me  as  natural  and  in- 
evitable, which  was  all  the  more  sad,  because  they 
affected  human  existence. 

Confronted  by  the  mysterious,  inaccessible  living 
organism  of  which  I  understood  so  little,  how  could 
I  determine  what  living  forces  governed  it,  what 
were  the  infinitely  refined  processes  which  were  cease- 
lessly in  operation  within  it?  What  was  the  es- 
sence of  the  action  of  those  medicines  which  we  em- 
ployed, wherein  lay  the  secret  of  the  germination 
and  development  of  disease?  In  the  human  organ- 
ism Koch's  bacilli  call  forth  consumption;  Loef- 
fler's — which  are  so  similar  in  outward  appearance 
— cause  diphtheria.  What  was  the  explanation? 
I  inject  a  solution  of  apomorphin  beneath  the  pa- 
tient's skin :  it  circulates  through  his  or  her  body  in- 
differently, but  on  coming  into  contact  with  an 
emetic  centre,  causes  nausea;  I  am  not  even  vouch- 
safed a  hint  as  to  the  chemical  affinities  of  the  nerve- 
cells  of  these  centres  and  apomorphin,  which  on  com- 


MEDICINE  AN  ART  125 

ing  into  contact  with  each  other,  call  forth  vomiting. 
A  young  girl,  suffering  from  migraine,  applies  to  me. 
What  is  migraine?  When  the  fit  is  upon  her,  the 
patient's  forehead  becomes  cold,  the  pupils  dilate; 
the  girl  is  ansemic;  all  this  tends  to  show  that  her 
migraine  results  from  the  irritation  of  the  sympa- 
thetic nerve,  in  consequence  of  general  poverty  in 
blood.  An  excellent  explanation,  forsooth!  For 
why,  and  in  what  way,  does  ansemia  call  forth  irri- 
tation of  the  sympathetic  nerve  in  this  case"? 
Wherein  lie,  and  what  do  the  curative  forces  of  the 
organism,  which  battle  with  the  disorder,  consist  in 
— those  forces  which  I  seek  to  strengthen'?  What 
is  the  effect  of  that  phenacetin  and  caffein  which  I 
prescribe  upon  the  spasm  of  the  sympathetic  nerve, 
or  of  the  iron  in  cases  of  ansemia'?  Thus  it  comes 
to  pass  that  the  patient  applies  to  me  for  relief, 
which  I  undertake  to  give  her — and  which,  perhaps, 
I  may  be  successful  in  affording — and  at  the  same 
time  I  understand  nothing  of  her  complaint  and  of 
the  way  in  which  my  physic  will  do  her  good. 

I  lack  so  much  as  a  distant  idea  of  the  typical 
processes,  common  to  all  human  organisms;  and  at 
the  same  time  each  and  every  patient  rises  up  before 
me  in  all  the  wealth  and  variety  of  his  individual 
peculiarities  and  deflections  from  the  normal  aver- 
age. What  can  I  know  of  these?  Two  apparently 
perfectly  healthy  people  may  get  wet  feet:  the  one 
catches  a  cold  in  the  head,  the  other  develops  acute 


126     THE  MEMOIRS  OF  A  PHYSICIAN 

rheumatism  of  the  joints;  why?  .  .  .  The  highest 
dose  of  morphia  is  three  centigrammes :  an  adult  and 
far  from  weak  female  patient  received  an  injection 
of  five  ;;7///2grammes  of  the  hypnotic  and  died;  for 
the  explanation  of  such  facts  a  special  word  exists  in 
medicine — "idiosyncrasy,"  but  that  word  gives  me 
no  clue  to  the  detection  of  such  cases  beforehand. 
.  .  .  The  maximal  quantity  of  chloral  that  may  be 
taken  during  the  twenty- four  hours,  is  five  grammes : 
recently  a  Dr.  Davis  communicated  that  a  patient, 
suffering  from  toothache,  took  sixty  grammes  of 
chloral  in  the  course  of  three  days,  without  any  in- 
jury to  health;  in  other  words,  he  absorbed  twenty 
grammes  in  the  twenty- four  hours;  and  I  have  no 
reason  for  doubting  the  truth  of  the  statement.  If 
the  author  had  written  160  instead  of  60 — I  also 
could  not  give  him  the  lie  direct — so  limited  is  our 
knowledge  of  man  in  his  peculiarities. 

What  means  am  I  provided  with  by  science  for 
penetrating  the  veil  which  envelops  the  living  organ- 
ism, for  the  discovery  of  its  ills'?  Of  course  some- 
thing is  vouchsafed  me.  For  instance,  a  patient 
may  be  feverish,  complain  of  pains  in  the  joint,  his 
spleen  and  liver  are  enlarged.  I  take  a  drop  of  his 
blood  and  examine  it  beneath  the  microscope :  in  the 
midst  of  the  blood  corpuscles  fine  spiral  creatures 
rapidly  wriggle  about;  these  are  the  spirals  of 
relapsing  fever,  and  I  diagnose  accordingly  with 
absolute  assurance.     If  science  gave  me  equally  re- 


MEDICINE  AN  ART  127 

liable  means  for  the  distinguishing  of  all  illnesses 
and  of  all  the  peculiarities  of  each  individual  sys- 
tem I  should  feel  that  I  had  something  at  least  to  go 
upon.  But  in  the  overwhelming  majority  of  cases 
there  is  nothing  of  the  kind  present.  I  must  draw 
my  inferences  from  the  most  trivial  data,  although 
my  patient's  life  and  health  may  depend  upon  my 
diagnosis.  ... 

I  was  one  day  called  in  to  attend  an  old  maid  of 
about  fifty,  the  owner  of  a  small  house  in  an  un- 
fashionable suburb  of  St.  Petersburg.  She  lived  in 
three  small,  low-ceilinged  rooms  hung  with  holy 
pictures  and  lamps,  with  an  old  friend  of  her  child- 
hood, crabbed,  yellow  and  bony  as  herself,  as  sole 
companion.  The  patient,  who  was  of  very  nervous 
and  hysterical  aspect,  complained  of  palpitations  and 
pains  in  the  chest;  every  day,  at  about  five  o'clock, 
she  experienced  great  shortness  of  breath  and  what 
seemed  to  be  difficulty  in  swallowing. 

"Don't  you  feel  as  if  you  had  a  ball  in  your 
throat  when  you  swallow'?"  I  asked,  having  in  my 
mind  that  well-known  symptom  of  hysteria — globus 
^hystericus, 

"Yes,  yes,  that's  just  how  I  feel  I"  exclaimed  my 
patient. 

The  most  careful  examination  of  both  heart  and 
lungs  showed  them  to  be  sound;  it  was  plain  that 
this  was  a  case  of  hysteria.  I  prescribed  accord- 
ingly. 


128     THE  MEMOIRS  OF  A  PHYSICIAN 

"But,  doctor,  do  you  think  that  I  may  die  sud- 
denly'?" she  asked. 

She  then  told  me  that  she  intended  leaving  the 
house  to  her  friend,  as  otherwise  that  small  property 
would  pass  into  the  hands  of  the  only  legal  heir,  her 
brother,  a  rascal  and  a  scamp  who  had  fraternally 
borrowed  all  her  money  without  security,  in  all 
about  six  hundred  pounds,  and  now  declined  to  re- 
turn it. 

"\^niat  a  strange  question  to  ask !  Who  is  to  pre- 
vent you  from  making  your  will?"  I  remarked. 
"There  is  no  immediate  danger,  but  one  never  knows 
what  may  not  happen!  You  may  as  soon  get  run 
over  by  a  tram-car  in  the  street.  Of  course  it's  al- 
ways best  to  make  one's  will  in  good  time." 

"You  are  right,  quite  right  I"  she  murmured 
thoughtfully.  "As  soon  as  I  am  better  I'll  go  to 
the  notaire'^ 

This  was  at  three  o'clock.  And  at  five,  two  hours 
later,  her  companion  rushed  into  my  room  sobbing, 
and  told  me  that  her  friend  was  dead:  while  in  the 
act  of  rising  from  dinner,  she  suddenly  staggered, 
went  white,  the  blood  gushed  from  her  mouth  and 
she  fell  down  a  corpse. 

"Oh,  why,  why  didn't  you  tell  us,  doctor*?"  the 
poor  woman  kept  on  repeating,  weeping,  gasping 
and  striking  her  side  frenzledly  with  her  clenched 
fist.  "I  shall  have  to  go  begging  now,  the  wretch 
will  turn  me  into  the  street!" 


MEDICINE  AN  ART  129 

Now  that  it  was  too  late,  I  understood;  the  diffi- 
culty in  swallowing  towards  evening  (after  dinner), 
which  I  explained  as  globus  hystericus^  was  caused 
by  the  swelling  of  an  aneurism,  in  consequence  of  in- 
creased pressure  of  the  blood  after  partaking  of  food. 
.  .  .  But  what  good  could  such  a  late  diagnosis  do? 

In  such  cases  I  used  to  give  way  to  rage  and  de- 
spair: what  value  could  a  science,  that  left  me  so 
blind  and  helpless,  have?  Why,  I  felt  like  a  crim- 
inal and  dared  not  face  this  unfortunate  woman  I 
had  made  a  pauper — and  at  the  same  time,  who 
could  lay  the  blame  at  my  door? 

And  this  feeling  recurred  the  oftener  as  time  went 
by.  Even  when  my  diagnosis  appeared  to  me  to  be 
clearly  indicated,  as  in  the  case  just  described,  actu- 
ality constantly  showed  me  to  be  in  the  wrong; 
and  oftener  still,  I  stood  before  the  patient  com- 
pletely nonplussed  from  the  outset:  how  was  I  to 
draw  any  conclusion  from  the  misty  and  obscure 
indications  with  which  his  case  furnished  me?  And 
for  whole  nights  I  would  pace  up  and  down  my  room 
pondering  upon  the  data,  piecing  them  together,  and 
never  arriving  at  any  definite  conclusion.  When 
ultimately  I  did  diagnose,  I  could  never  shake  off 
the  haunting  thought:  "What  if  my  guess  be 
wrong?  How  am  I  to  verify  its  correctness?" 
And  to  think  that  I  had  to  live  my  life  through,  be- 
neath the  depressing  weight  of  such  constant  uncer- 
tainty I 


130     THE  MEMOIRS  OF  A  PHYSICIAN 

But  assuming  that  I  had  diagnosed  the  disease 
aright,  I  now  had  to  treat  it.  What  guarantee  does 
science  give  me  that  the  remedies  it  recommends 
are  really  efficacious  and  to  the  points  The  action 
of  most  of  them  is  in  the  highest  degree  obscure  to 
us,  and  the  indications  to  their  application  are  most 
empirically  set  down  through  clinical  observation. 
We  already  know,  however,  how  unstable  and  de- 
ceiving clinical  observation  is.  A  given  remedy  acts 
excellently  according  to  the  unanimous  testimony  of 
the  profession,  and  in  a  year  or  two  it  is  thrown 
overboard  as  useless  or  even  injurious.  Koch's 
tuberculine  lorded  it  for  two  years — they  saw  with 
their  own  eyes  what  a  * 'brilliant"  effect  it  had  in 
combating  tuberculosis ! 

In  that  infinitely  complicated  and  obscure  process 
of  which  the  life  of  the  diseased  organism  consists, 
thousands  of  factors  are  active — the  incalculable 
malignant  effects  of  the  disease  in  question,  the  pa- 
tient's surroundings,  all  the  innumerable  forms  taken 
by  the  curative  and  resisting  forces  inherent  in  the 
human  body — and  to  all  these  is  added  a  thousand- 
and-first  influence  in  the  shape  of  the  remedy  pre- 
scribed by  the  physician.  How  to  determine  what 
its  concise  action  may  be^  The  ancient  Grecian 
physician  Chrysippus  forbade  food  to  the  fever- 
stricken,  Diocippus  allowed  them  no  drink,  Sylvius 
made  them  sweat,  Broussais  bled  them  until  they 


MEDICINE  AN  ART  131 

fainted,  Currie  placed  them  in  cold  baths — and  each 
considered  his  method  to  be  the  most  efficacious. 
The  physicians  of  the  Middle  Ages  considered  that 
the  employment  of  salves  made  from  human  dung 
was  a  very  good  remedy  for  cancer.  During  the 
eighteenth  century  the  lancing  of  the  gums  used  to 
be  repeated  dozens  of  times  upon  infants  to  ease 
their  teething,  it  was  even  practised  upon  mites  ten 
days  old;  as  late  as  1842,  Underwood  recommended 
the  slitting  of  the  gums  right  round,  and  insisted  on 
the  incision  being  deep,  to  the  very  teeth,  alleging 
that  "no  injury  to  the  latter  need  be  feared."  .  .  . 
All  this  was  very  beneficial,  according  to  the  doctor's 
opinion!  .  .  . 

I  entered  practice  with  a  definite  store  of  thera- 
peutic knowledge,  with  which  my  university  had 
furnished  me.  What  employment  was  I  to  give  it^ 
Clearly  I  ought  to  apply  it  practically  with  cool 
confidence.  But  no  sooner  did  I  try  to  do  so,  than 
disenchantment  set  in.  Decoction  of  senega  is  rec- 
ommended for  provoking  cough,  when  it  is  neces- 
sary to  free  the  lungs  from  the  loose  phlegm  filling 
them.  When  I  prescribed  the  leaf  I  used  to  try  to 
detect  its  action,  but  not  in  a  solitary  instance  did  I 
feel  justified  in  declaring  that  the  physic  had  con- 
duced to  the  increase  of  the  patient's  expectoration 
by  a  single  drop.  .  .  .  Perhaps  iron  would  be  pre- 
scribed in  cases  of  ansemia,  but  even  when  the  pa- 


132     THE  MEMOIRS  OF  A  PHYSICIAN 

tient  got  better,  I  could  never  be  sure  that  the  im- 
provement in  nis  or  her  condition  was  in  the  slight- 
est measure  due  to  the  tonic  administered. 

In  fact,  I  was  expected  to  believe,  on  hearsay, 
that  those,  and  many  other  remedies,  acted  exactly 
in  the  way  described — such  was  the  logical  con- 
clusion to  be  drawn.  But  science  itself  precluded 
such  faith  by  unceasingly  undermining  it.  Ex- 
amples are  not  far  to  seek.  One  of  the  drugs  most 
frequently  given  to  phthisical  patients,  is  creosote 
and  its  derivatives.  At  the  same  time  voices,  grow- 
ing ever  more  and  more  persistent,  declare  that  creo- 
sote is  not  of  the  slightest  use,  that  it  is  merely  a  kind 
of  hall-mark  for  the  consumptive.  The  funda- 
mental rule  of  diet  in  typhoid  requires  that  the  pa- 
tient be  fed  exclusively  on  liquid  food;  but  now  the 
tide  has  turned,  and  a  current  of  opinion,  ever-in- 
creasing in  volume,  declares  that  by  so  doing  we  pur- 
poselessly starve  the  sufferer.^  Arsenic  is  held  to  be 
an  invaluable  remedy  for  many  skin  diseases, 
anaemia,  malaria;  suddenly  a  medical  journal  of 
reputation  publishes  the  following  remarks: 
"What  is  most  remarkable  in  the  history  of  arsenic, 
is  the  fact  that  it  never  lost  its  popularity  amongst 
doctors,  murderers  and  horse-dealers.  .  .  .  Doctors 
ought  at  last  to  understand,  that  arsenic  gives  then 

^  To-day  the  patient  is  not  fed  exclusively  a  milk  diet  but  is  given 
almost  everything  fed  to  a  normal  person  except  meat.  This  feed- 
ing is  in  such  quantities  that  the  patient  gains  in  weight  rather  than 
loses. 


MEDICINE  AN  ART  133 

too  little  to  warrant  such  eternal  veneration.  The 
survival  of  the  arsenic  myth  is  the  shame  of  our 
therapeutics." 

In  the  beginning,  such  unlocked  for  criticisms 
simply  bewildered  me.  What  was  I  to  believe? 
And  the  conviction  grew  upon  me,  that  I  ought  to 
believe  nothing,  ought  to  accept  nothing  unchal- 
lenged, ought  to  suspect  all,  discard  all,  and  only 
take  back  what  my  personal  experience  had  shown 
me  to  be  efficacious.  But  in  that  case,  where  did  the 
medical  experience  of  centuries  come  in,  what  value 
could  it  have? 

A  certain  young  doctor  asked  the  great  Syden- 
ham., the  "English  Hippocrates,"  what  books  it  was 
necessary  to  read  to  become  a  good  physician. 

"Read  'Don  Quixote,'  my  friend,"  answered  Sy- 
denham. "It  is  a  very  good  book  and  I  often  re- 
peruse  it." 

But  this  is  awful !  This  means  that  there  can  be 
no  tradition,  no  pre-emption  of  observation;  "Learn 
to  study  life  without  any  prejudice,  and  each  of  you 
learn  from  the  beginning  I" 

Since  Sydenham  gave  utterance  to  his  pithy  re- 
mark, more  than  two  centuries  have  passed.  Medi- 
cine has  made  gigantic  strides,  it  has  become  in  many 
respects  a  science;  but  tremendous  vistas  still  exist, 
in  which  Cervantes,  Shakespeare  and  Tolstoi,  who 
have  no  relationship  whatever  to  medicine,  remain 
the  best  teachers. 


134     THE  MEMOIRS  OF  A  PHYSICIAN 

But  once  forced  to  distrust  the  experience  of 
others,  dared  I  believe  my  own?  Supposing  that 
I  had,  through  personal  experiment,  become  con- 
vinced of  the  efficacy  of  a  given  remedy ;  how  was  I 
to  say  how  it  acted,  and  why  it  acted  thus*?  So 
long  as  its  action  was  not  fully  explained  to  my 
mind,  there  was  nothing  to  guarantee  that  my  sub- 
jective impression  was  not  an  optical  illusion.  All 
my  previous  scientific  training  protested  against  such 
a  crude  and  empirical  mode  of  procedure,  against 
such  groping  about  with  shut  eyes.  But  the  op- 
pressiveness of  this  state  of  affairs  made  itself  felt, 
by  contrast,  most  acutely  of  all  when  I  left  the  un- 
stable and  oozy  ground  of  empiricism  and  emerged 
once  more  upon  the  firm  road  of  science.  In  ab- 
dominal surgery  there  is  always  danger  of  septic  in- 
fection of  the  peritoneum;  but  I  know  what  to  do 
to  avert  it:  if  I  employ  instruments  that  have  been 
boiled,  if  I  carefully  disinfect  my  hands  previous  to 
operating,  infection  cannot  take  place.  The  proper 
concave  glasses  must  help  the  short-sighted  indi- 
vidual. A  dislocated  elbow,  if  there  be  no  compli- 
cations, must  return  to  its  socket,  if  the  proper 
manipulations  be  resorted  to.  In  all  such  cases, 
pre-emption  is  indispensable  to  the  practitioner;  one 
has  to  read  and  knov/  something  besides  ''Don 
Quixote."  Of  course,  both  error  and  progress  are 
possible  in  this  sphere  as  well  as  elsewhere;  but  mis- 
takes will  result  either  from  my  insufficient  training 


MEDICINE  AN  ART  135 

or  inexperience — ^progress  will  be  made  by  improv- 
ing the  older  methods,  not  by  repudiating  them. 
The  future  of  our  science  is  brilliant  and  indubitable. 
Its  attainments,  up  to  the  present  time,  serve  to 
demonstrate  what  it  will  arrive  at  in  times  to  come : 
complete  understanding  of  the  normal  and  diseased 
organism,  of  the  individual  peculiarities  of  each 
separate  unit,  a  complete  grasp  of  the  action  of  every 
remedy  employed — these  achievements  will  go  to 
build  up  its  foundations. 

"When  physiology,''  says  Claude  Bernard,  "shall 
have  given  all  that  we  have  a  right  to  expect  of  it, 
it  will  have  become  transformed  into  medicine, 
which  will  then  be  a  theoretical  science;  and  from 
this  theory  will  be  deduced,  as  in  other  sciences,  the 
necessary  adaptations,  i.e.  applied  practical  medi- 
cine." 

But,  alas,  how  immeasurably  far  removed  are  we 
still  from  such  an  age!  And  this  reflection  led  to 
the  ever  more  frequent  recurrence  of  the  question: 
Until  we  arrive  so  far,  what  sense  can  there  be  in 
the  practice  of  medicine  at  all?  Wherein  lies  the 
raison  d'etre  of  this  game  at  blind-man's-buff"? 
Why  should  society  be  deceived  by  a  make-believe 
"medical  science"?  Let  homoeopathists  and  their 
kind  devote  themselves  to  that  sort  of  thing — they 
who  would  compress  the  endless  varieties  of  the 
life-processes  into  one  or  two  dogmatic  formulae! 
Our  task  can  only  be  one — to  work  for  the  future, 


136     THE  MEMOIRS  OF  A  PHYSICIAN 

to  try  to  know  and  conquer  life  in  all  its  complexity 
and  breadth.  In  regard  to  the  present,  we  can  but 
repeat  the  words  of  Averroes,  an  Arab  writer  of  the 
Middle  Ages:  "An  honest  man  may  derive  pleas- 
ure from  the  theory  of  the  physician's  art,  but  his 
conscience  will  never  allow  him  to  pass  on  to  medical 
practice,  however  vast  be  his  knowledge." 

I  sought  solace  from  this  thought  each  time  that 
I  felt  the  impenetrable  darkness  in  which  I  was 
forced  to  work,  owing  to  the  imperfection  of  my 
science,  oppressing  me  too  heavily.  I  perfectly  well 
understood  that  the  idea  was  preposterous:  the  un- 
systematic and  doubting  medicine  of  to-day  no  doubt 
leaves  much  to  be  desired,  but  still  it  is  of  incal- 
culably greater  practical  utility  than  all  the  systems 
ever  evolved  by  the  human  brain  alone,  or  crude  em- 
pirical generalisations.  Also,  it  is  conscience  which 
prevents  the  physician  from  compelling  the  sick  to 
seek  the  aid  of  quacks  and  falling  into  the  grasp  of 
the  homoeopathists,  various  pastors  Kneip  and  other 
charlatans.  I  must  confess  here,  that  I  was  ever  be- 
coming more  and  more  convinced,  in  my  inner  con- 
sciousness, of  my  utter  personal  disqualification  for 
the  profession  of  a  doctor,  and  that,  in  betrothing 
myself  to  medicine,  I  had  lacked  the  most  distant 
conception  of  that  standard  to  which  every  physician 
must  come  up.  And  it  was  with  the  above  sophisms 
as  to  the  unfitness  of  the  science  of  the  day  that  I 
sought  to  stifle  this  terrible  thought. 


MEDICINE  AN  ART  137 

Thanks  to  the  shortcomings  of  theoretical  medi- 
cine, as  it  stands  at  the  present  day,  practical 
medicine  can  only  be  an  art,  not  a  science.  To  pre- 
cisely understand  the  significance  of  the  above,  it  is 
necessary  to  experience  in  person  all  that  this  in- 
volves. Had  I  not  examined  the  patient,  who  died 
of  aneurism,  most  conscientiously,  applying  all  that 
science  demanded  from  me,  to  fall  into  gross  error 
nevertheless  *?  Had  a  born  physician  been  in  my 
place,  he  would  have  diagnosed  rightly :  his  peculiar 
creative  faculty  would  have  discovered  a  mass  of 
impalpable  symiptoms  v/hich  had  escaped  me; 
through  sub-conscious  inspiration  he  would  have  thus 
filled  the  void  left  by  the  absence  of  clearer  indi- 
cations, guessing  what  I  was  incapable  of  divining. 
Only  a  man  thus  gifted  can  answer  to  the  require- 
ments of  the  ideal  doctor,  for  talent  is  as  necessary 
here  as  it  is  to  produce  the  true  poet,  artist  or 
musician. 

Whereas  I  had  imagined,  when  entering  myself 
at  the  Faculty  of  Medicine,  that  it  was  possible  to 
learn  that  art.  ...  I  fondly  believed  that  a  certain 
level  of  knowledge  and  a  certain  degree  of  mental 
development  were  all  that  I  required;  that  these 
qualifications  would  enable  me  to  master  medicine 
in  the  same  way  as  any  applied  science,  such,  for 
example,  as  chemical  analysis. 

When  medicine  shall  have  become  a  science  in  the 
completest  sense  of  the  word,  single,  universal  and 


138     THE  MEMOIRS  OF  A  PHYSICIAN 

infallible,  its  acquisition  by  the  average  man  will  be 
possible.  But  at  present  it  is  as  far  beyond  our 
powers  to  learn  medicine,  i.e.  the  healing  art,  as  to 
become  poets  or  actors  at  will.  There  are  shoals  of 
excellent  theorists,  genuinely  "scientific"  medical 
men,  who  are  not  worth  a  brass  farthing  in  actual 
practice. 

But  why  should  I  have  been  entirely  ignorant  of 
all  this,  when  embarking  on  my  studies  ^  Why  was 
I  possessed  of  such  a  cloudy  and  perverted  concep- 
tion in  general  of  what  awaited  me  ?  .  .  .  How  very 
simply  everything  came  to  pass!  We  handed  in 
our  papers  and  certificates,  were  entered  as  students 
of  the  Medical  Faculty,  and  the  professors  com- 
menced their  lectures  forthwith.  And  not  one  of 
our  preceptors  opened  our  eyes  for  us  as  to  the  fu- 
ture, no  one  explained  what  awaited  us  in  our  life's 
work. 

While  we  ourselves  imagined  everything  to  be  so 
simple  and  so  obvious !  You  examined  the  patient 
and  said:  he  (or  she)  suffers  from  such-and-such  a 
disease;  he  (or  she)  must  take  this  or  that,  and  such- 
and-such  treatment  must  be  applied!  The  scales 
had  now  fallen  from  my  eyes,  but  the  knowledge  of 
my  mistake  was  bought  at  the  price  of  seven  of  the 
best  years  of  my  life. 

I  was  utterly  dispirited.  Half-heartedly,  I  still 
continued  in  my  duties,  laughing  bitterly  in  my  soul 
at  the  patients  who  were  simple  enough  to  apply  to 


MEDICINE  AN  ART  139 

mc  for  aid :  they  also  thought,  as  I  had  done  before 
them,  that  he  who  had  completed  a  course  of  study 
at  the  Medical  Faculty  was  a  doctor.  They  knew 
not  that  there  were  as  few  physicians  in  the  world  as 
there  were  poets,  that  the  ordinary  human  doctor  was 
an  absurdity,  while  science  remained  in  its  present 
state.  And  why  should  I  continue  in  bondage  to 
this  folly*?  I  ought  to  get  out  I  Anything  rather 
than  remain  in  the  false  and  criminal  role  of  an  im- 
postor I 

For  two  years  this  state  of  affairs  dragged  on. 
Then  little  by  little  came  humility. 

It  was  true  that  science  gave  me  less  than  I  had 
anticipated,  and  that  I  was  no  genius.  But  would 
I  be  in  the  right  if  I  renounced  my  diploma  *?  If, 
at  a  given  moment,  art  were  to  lack  a  Tolstoi  or  a 
Beethoven,  we  could  dispense  with  them;  but  the 
suffering  cannot  wait;  tens  of  thousands  of  Bee- 
thovens  and  Tolstois  would  be  necessary  for  the 
satisfying  of  all  their  wants.  And  of  course  they 
would  never  be  forthcoming. 

Things  being  so,  were  we  average  doctors  so 
utterly  useless?  For  after  all,  if  we  regard  the 
matter  in  the  abstract,  science  has  added  much  to 
its  possessions  at  the  expense  of  art,  and  year  by 
year  its  conquests  extend.  And  in  the  province 
of  science,  at  least,  we  are  masters.  Even  in  the 
rest  of  medicine  we  can  be  useful  and  accomplish 
much — on  condition  of  rigid  adherence  to  the  old 


140     THE  MEMOIRS  OF  A  PHYSICIAN 

maxim,  "primum  non  nocere"  This  must  be  our 
first  consideration.  And  in  the  next  place  we  must 
once  and  for  all  discard  the  notion  that  our  work 
consists  in  careless  and  unquestioning  obedience  to 
the  mandates  of  science.  We  must  fully  realise 
how  complex  and  responsible  the  work  before  us  is, 
must  study  each  patient  with  an  unrelaxed  conscious- 
ness of  the  novelty  of  his  disease,  work  unceasingly 
at  self-improvement,  never  resting  or  pausing  in  our 
quest  for  the  truth. 

All  this  is  terribly  hard  and  many  may  faint  be- 
neath the  burden;  but  as  long  as  I  find  strength  to 
bear  it  honestly,  I  have  the  right  to  remain  at  my 
post. 


CHAPTER  IX 

THE    QUESTION    OF    VIVISECTION 

IN  those  days  of  doubt  and  disillusion,  I  found 
special  solace  in  scientific  work.  Here,  in  pure 
science,  one  had  no  need  to  grope  about  in  obscur- 
ity; it  was  possible  to  institute  complete  control  over 
one's  every  step,  to  verify  each  result  obtained;  here 
reigned  supreme  those  severe  scientific  methods 
which  medical  practice  set  so  contemptuously  at 
nought.  "Better  to  add  one  tiny  brick  to  the  edi- 
fice of  the  great  medical  science  of  the  future," 
thought  I,  "than  to  carry  water  in  a  sieve  by 
striving  to  accomplish  what  is  beyond  my  under- 
standing." 

Among  other  things,  I  pursued  researches  as  to 
the  part  played  by  the  spleen  in  resisting  infectious 
diseases.  Two  monkeys  of  the  Macacus  species 
were  purchased  by  our  laboratory,  for  inoculation 
with  relapsing  fever.  During  the  three  weeks  they 
remained  with  us,  before  the  commencement  of  our 
experiments,  I  had  time  to  become  greatly  attached 
to  them,  especially  to  the  male  specimen,  whom  we 
had  named  "Stepka." 

Whenever  I  entered  the  laboratory,  he  used  to 
rush  up  to  the  front  bars  of  his  roomy  cage,  in  ex- 

141 


142     THE  MEMOIRS  OP  A  PHYSICIAN 

pectation  of  a  present  of  sugar.  After  having  fed 
my  pets,  I  used  to  let  them  out.  The  female 
"Jilda"  was  more  timid;  she  would  run  about  the 
floor  clumsily,  looking  round  at  me  in  fear.  If  I 
made  a  slight  movement  she  would  turn  and  fly 
back  to  the  cage.  Stepka,  however,  treated  me 
quite  as  a  familiar  chum.  As  soon  as  I  sat  down, 
he  would  immediately  clamber  on  to  my  knees  and 
begin  to  search  my  pockets,  eyebrows  lifted  and  his 
large  close-set  eyes  peering  forth  with  comical  seri- 
ousness. Pulling  my  percussional  mallet  from  my 
breast  pocket,  he  would  set  up  a  surprised  cry,  his 
eyes  open  wide,  and  then  commence  to  examine  the 
bright  instrument  with  minute  curiosity. 

After  having  gazed  hi5  fill,  Stepka  would  drop 
the  hammer  on  to  the  floor,  and  with  the  same  mel- 
ancholy seriousness,  as  if  performing  a  necessary, 
but  very  tiresome  task,  proceed  with  his  search  of 
my  person.  Carefully  taking  me  by  the  beard,  he 
would  remove  my  glasses  with  his  thin  brown 
fingers.  .  .  .  But  all  this  soon  palls  on  him. 
Stepka  climbs  up  on  to  my  shoulder,  sighs,  looks 
about  him,  then,  espying  a  corked  phial,  of  a  sudden 
— quick  as  a  dart — springs  on  to  the  table — his 
favourite  amusement  is  the  uncorking  of  bottles. 
Stepka  quickly  and  neatly  draws  the  stopper,  stows 
it  away  in  his  cheek-pouch,  and  tries  to  escape  to 
the  ceiling  via  the  blinds:  he  knows  that  I  will  de- 
prive him  of  his  prize.     I  capture  him  half-way. 


THE  QUESTION  OF  VIVISECTION     143 

"Tsi-tsi-tsi  I"  he  chatters  with  displeasure,  draw- 
ing in  his  head,  screwing  up  his  eyes  and  trying  to 
get  away.  I  possess  myself  of  his  play-thing. 
Stepka  contemplates  the  scene  sorrowfully.  Sud- 
denly his  eyes  brighten;  he  jumps  on  to  the  window- 
sill  and  begins  to  chatter  excitedly.  Outside  a  cab 
is  drawn  up  in  the  street ;  Stepka  cranes  his  neck,  and 
stares  at  the  horse  with  insatiable  inquisitiveness. 
I  stroke  him,  but  he  removes  my  hand  impatiently 
with  his  own  little  paw,  settles  down  more  comfort- 
ably and  continues  to  scrutinise  the  horse.  A  dog 
runs  across  the  street.  Stepka  is  all  alert,  the  fur 
on  his  neck  and  back  bristling  up,  his  eyes  become 
restless,  and  he  again  commences  his  chattering, 
greatly  excited,  and  peers  first  through  one  pane, 
then  through  another.  The  dog  runs  away. 
Stepka  scampers  across  the  long  table,  upsetting 
glasses,  and  follows  the  dog  out  of  sight,  from  win- 
dow to  window. 

One  might  have  passed  whole  hours  in  the  rascal's 
company  without  being  bored.  I  felt  that  a  bond 
of  common  sympathy  united  us,  and  that  we  had 
arrived  at  mutual  understanding. 

I  did  not  like  the  idea  of  cutting  out  his  spleen 
myself,  and  a  comrade  performed  the  task  for  me. 
When  the  wound  healed,  I  inoculated  Stepka  with 
typhoid.  When  I  entered  the  laboratory  now, 
Stepka  no  longer  rushed  to  the  bars  as  of  yore ;  weak 
and  ruffled,  he  sat  motionless  in  his  cage,  staring  at 


144    THE  MEMOIRS  OF  A  PHYSICIAN 

me  with  strange  darkened  eyes;  every  day  he  got 
worse;  when  he  essayed  to  climb  on  to  his  perch, 
his  hands  failed  him,  he  lost  his  hold  and  fell  to  the 
bottom  of  his  dwelling.  Finally,  he  became  too 
weak  to  rise  at  all;  wasted,  he  lay  still  with  grin- 
ning teeth,  and  moaned  hoarsely.  And  it  was  be- 
fore my  eyes  that  Stepka  died. 

An  obscure  martyr  to  science,  he  lay  a  corpse  be- 
fore me.  I  gazed  upon  that  pitiful  little  body, 
upon  that  pretty  naive  little  face,  from  which  the 
death-agony  even  had  been  powerless  to  efface  its 
customary  serio-comic  expression,  and  experienced 
a  most  unpleasant  feeling.  To  tell  the  truth,  at 
heart  I  was  a  little  ashamed  of  myself.  When  I 
recalled  all  his  engaging  little  tricks  and  funny  ways, 
I  could  not  drive  away  certain  vague  misgivings  as 
to  whether  my  crime  had  been,  after  all,  so  very 
many  times  less  grave  than  if  it  had  been  per- 
petrated upon  a  child?  Such  sentimentality,  in  re- 
gard to  the  lower  animals,  strikes  you  as  ridiculous? 
But  are  the  criteria  of  sentimentality  so  very  hard 
and  fast  and  immutable?  Two  thousand  years  ago 
how  loudly  would  a  Roman  Patrician  have  laughed 
at  the  sentimental  person  who  expressed  indignation 
at  his  casting  a  slave,  guilty  of  breaking  a  vase,  to 
the  murense.  In  his  eyes  a  slave  was  a  "lower  ani- 
mal" too. 

Descartes  looked  upon  animals  as  simple  auto- 
mata, animated  but  soulless  bodies;  according  to 


THE  QUESTION  OF  VIVISECTION     145 

his  opinion,  there  existed  in  them  exclusively  cor- 
poreal, purely  sub-conscious  manifestations  of  those 
emotions  which  we  call  spiritual.  Malebranche 
held  the  same  views.  "Animals,"  he  said,  "eat 
without  pleasure,  cry  without  experiencing  pain; 
they  desire  nothing  and  knov/  nothing." 

Is  it  possible  to  accept  such  statements  as  these 
nowadays'?  Leaving  ordinary  everyday  observa- 
tion, which  cries  aloud  against  such  a  blind  theory, 
out  of  the  question,  how  can  we,  the  followers  of  the 
principles  of  evolution  in  natural  science,  acquiesce 
with  the  above? 

The  only  possible  view  to  take  seems  to  be  that 
expressed  by  Huxley,  who  held  that  the  great  doc- 
trine of  continuity  did  not  permit  us  to  suppose  that 
anything  in  nature  could  spring  into  existence  spon- 
taneously and  without  antecessors,  without  going 
through  a  process  of  gradual  transformation,  and 
that  there  could  be  no  disputing  that  the  lower  verte- 
brate animals  possessed  in  a  less  developed  form  that 
part  of  the  brain  which  we  have  every  reason  to 
believe  to  be  the  organ  of  our  consciousness.  And 
therefore,  that  it  was  highly  probable  that  the  lower 
animals  possessed  consciousness  in  proportion  to  the 
development  of  their  organ  of  consciousness,  ex- 
periencing, in  more  or  less  definite  form,  the  same 
emotions  as  we  do  ourselves.  Once  this  is  so,  once 
it  be  true  that  we  are  not  divided  by  the  rigid  line 
which  we  once  imagined  to  exist,  is  such  sentimen- 


146     THE  MEMOIRS  OF  A  PHYSICIAN 

tality  so  ludicrous,  are  these  twinges  of  conscience, 
which  we  experience  when  we  make  animals  suffer, 
so  false?  For  the  sensation  I  experienced  was  very 
much  akin  to  the  pricks  of  conscience.  One  of  my 
colleagues,  a  surgeon,  was  investigating  the  pecul- 
iarities of  abdominal  wounds  inflicted  by  fire-arms; 
he  sought  to  discover  whether  it  were  best  to  adopt 
a  waiting  policy,  or  to  proceed  immediately  to  oper- 
ate. His  method  was  to  discharge  a  revolver  into 
the  stomachs  of  dogs,  tied  to  boards,  a  few  yards 
away;  then  he  either  performed  laparotomy  imme- 
diately, or  else  allowed  his  canine  victims  to  remain 
without  operation.  On  entering  his  laboratory,  one 
was  struck  by  the  din  of  groans,  barking  and  yelp- 
ing, that  filled  the  room;  some  of  the  dogs  were  in 
their  death  throes,  others  lay  still,  whining  feebly. 
When  I  looked  upon  them,  I  did  not  feel  merely 
pained,  as  I  used  to  in  the  beginning,  when  contem- 
plating the  sufferings  of  men  under  operations;  the 
sensation  I  experienced,  when  gazing  upon  the  elo- 
quent eyes  of  those  dying  dogs,  ennobled  by  suffer- 
ing and  almost  human  in  their  expressiveness,  was 
that  of  malaise  and  shame.  At  such  moments  I 
understood  the  mood  of  Pirogoff  when  an  old 
man. 

"In  my  younger  days,"  we  read  in  his  posthumous 
memoirs,  "I  was  pitiless  to  suffering." 

"One  day,  as  I  remember,  this  indifference  to  the 
agony  of  animals  undergoing  vivisection  struck  me 


THE  QUESTION  OF  VIVISECTION     147 

with  such  force,  that  with  my  knife  still  in  my  hand, 
I  involuntarily  exclaimed,  turning  to  the  comrade 
who  was  assisting  me :  *Why,  at  this  rate  one  might 
cut  a  man's  throat.' 

"Yes,  much  can  be  said  in  favour  of  and  against 
vivisection.  There  can  be  no  doubt  that  it  is  an 
important  aid  to  science.  .  .  .  But  science  does  not 
entirely  fill  the  life  of  man;  the  enthusiasm  of  youth 
and  the  ripeness  of  manhood  pass  and  another  period 
of  life  ensues,  and  with  it  an  inner  call  for  introspec- 
tion; and  it  is  then  that  the  recollection  of  the  vio- 
lence used  upon,  the  tortures  inflicted  on  and  the 
sufferings  caused,  another  creature,  commence  to  pull 
at  one's  heart-strings  involuntarily.  It  seems  to 
have  been  the  same  with  the  great  Haller;  so  it  was 
with  me,  I  must  confess,  and  in  these  latter  years  I 
would  never  be  able  to  bring  myself  to  perform  the 
same  cruel  experiments  upon  animals  which  at  one 
time  I  carried  out  so  zealously  and  with  such  non- 
chalance." 

None  of  this  can  be  denied.  Mais  que  faire? 
To  renounce  vivisection  were  to  place  the  future  of 
medicine  in  jeopardy,  to  condemn  us  doctors  forever 
to  the  uncertain  and  barren  paths  of  clinical  obser- 
vation. 

It  is  necessary  to  grasp  fully  the  tremendous  im- 
portance of  vivisection  for  science,  to  be  able  to 
understand  that  there  is  but  one  way  out  of  the 
dilemma — that  of  stifling  the   reproaches  of  con- 


148     THE  MEMOIRS  OF  A  PHYSICIAN 

science,  of  choking  down  pity  and  closing  one's  eyes 
to  the  living  agony  of  the  animals  sacrificed. 

A  violent  agitation  has  been  conducted  in  Western 
Europe,  for  several  decades,  against  vivisection,  and 
of  late  the  campaign  has  been  taken  up  in  Russia 
too.  The  anti-vivisectionists  base  their  propaganda 
upon  an  assumption  diametrically  opposed  to  the 
principle  I  have  just  laid  down:  they  aver  that  vivi- 
section  is  entirely  unnecessary  to  science. 

But  who  are  these  persons  who  have  taken  upon 
themselves  the  task  of  proving  this  assertion  of 
theirs?  Clergymen,  society  ladies,  statesmen,  per- 
sons entirely  unassociated  with  science;  they  seek  to 
refute  Virchow,  Bernard,  Pasteur,  Robert  Koch  and 
other  colossuses,  who  carry  science  forward  upon 
their  broad  shoulders.  What  a  gigantic  absurdity! 
Profound  study  and  knowledge  are  necessary  for 
mastering  the  methods  of  science.  How  can  the 
uninitiated  take  upon  themselves  to  judge  in  such 
matters?  That  they  themselves  should  be  uncon- 
scious of  this  contradiction  is  impossible,  and  it  is 
easy  to  understand  with  what  joy  they  acclaim  those 
savants  who  express  themselves  in  sympathy  with 
the  movement.  A  while  ago,  the  anti-vivisectionists 
made  much  of  Lawson  Tait,  a  very  eminent  practi- 
cal surgeon,  and  of  an  entirely  obscure — as  far  as  the 
scientific  world  is  concerned — medical  man,  Charles 
Bell  Taylor.  On  November  i6th,  1892,  the  above 
mentioned   Charles    Bell   Taylor,    F.R.C.S.E.    and 


THE  QUESTION  OF  VIVISECTION     149 

M.D.  Edin.,  delivered  an  address  before  the  Medico- 
Surgical  Society  of  Nottingham,  in  condemnation  of 
vivisection.  The  address  was  circulated  amongst 
our  anti-vivisectionists  in  a  rather  ungrammatical 
translation,  as  a  supplement  to  the  Novoye  Vremja 
newspaper. 

While  reading  this  speech,  one  is  aghast  at  the 
mass  of  wilful  misrepresentations  with  which  it 
teems,  and  the  question  involuntarily  arises:  can  a 
doctrine,  which  employs  such  brazen-faced  methods 
of  public  deception,  have  any  vitality  in  it*?  Bol- 
stered up  by  his  authority  as  a  specialist,  and  confi- 
dent in  the  utter  ignorance  of  his  audience,  Bell 
Taylor  stops  at  nothing.  "It  is  true,"  he  declares, 
"that  Harvey  was  a  vivisector,  but  it  is  not  true  that 
he  discovered  the  circulation  of  the  blood  by  means 
of  vivisection ;  on  the  contrary,  so  long  as  he  confined 
his  attention  to  vivisection  he  was  continually 
wading  through  blood,  agony  and  torture,  only  to 
arrive  at  doubt,  uncertainty  and  contradiction." 
Proceeding,  Bell  Taylor  quotes  Harvey's  words: 
"  'I  was  led  to  distrust  the  existing  belief  of  the 
course  of  blood  by  considering  the  arrangement  of 
the  valves  of  the  veins'  "  (which,  of  course  could 
only  be  studied  on  the  dead  body,  adds  the  orator). 
"It  was  plain  that  the  commion  doctrine  that  the 
blood  moved  to  and  fro  in  the  veins  outward  from 
the  heart  and  back  again  was  incompatible  with  the 
fact  of  the  direction  of  the  valves,  which  are  so 


150     THE  MEMOIRS  OF  A  PHYSICIAN 

placed  that  the  blood  could  only  move  in  one  direc- 
tion." 

(We  must  here  remark,  that  Harvey's  celebrated 
treatise  on  the  circulation  of  the  blood  consists  almost 
entirely  of  descriptions  of  Ms  experiments  upon  liv- 
ing animals;  we  quote  the  headings  of  several  chap- 
ters of  his  treatise : — 

Chap.     II.  "£x    vivorum    dissectione    qualis    sit 

cordis  motus^ 
Chap.  III.  ''Arteriarum  motus  qualis  ex  vivorum 

dissectione.^^ 
Chap.  IV.  '''Motus  cordis  et  auriculorum  qualis 

ex  vivorum  dissectione T     Etc.)  ^ 

''Koch's  inoculations  with  tubercle,"  continues 
Bell  Taylor,  "which  were  adopted  from  experiments 
upon  animals,  have  led  to  death  from  initial  fever, 
the  infection  of  the  whole  system  of  patients,  who 
merely  suffered  from  localised  disease,  and  to  failure 
and  terrible  disappointment  to  patients  subjected  to 
it."  (It  will  be  remembered  that  the  address  was 
delivered  towards  the  close  of  1892,  when  there  was 
hardly  any  one  left  to  defend  Koch's  tuberculine; 
but  Bell  Taylor  was  discreetly  silent  on  the  fact  that 
it  was  through  vivisection  that  Koch  discovered  the 
tubercle  bacillus,  and  that  bacteriology,  in  its  en- 
tirety, was  created,  thanks  to  vivisection.) 

^  See  Exercitatio  anatomica  de  motu  cordis  et  saguinis  in  ani- 
malibus,    Auctore  Gulielmo  Harveo.    Lugduni  Batavorum.     1737. 


THE  QUESTION  OF  VIVISECTION     151 

And  so  on  ad  infinitum;  his  every  assertion  was 
either  a  direct  untruth,  or  a  gross  distortion  of  actual 
fact.  In  the  notes  furnished  below,  the  reader  will 
find  a  few  more  typical  samples  of  anti-vivisectionist 
literature ;  the  latter  are  culled  at  random  from  Eng- 
lish tracts  and  pamphlets,  which  are  everywhere 
being  circulated  in  thousands  by  the  "Anti- vivisec- 
tion Society."  ^ 

Vivisection  is  indispensable  to  medical  science — 

2  ".  .  .  We  have  to  consider  the  claims  of  vivisection  to  practical 
results,"  says  Dr.  Stephen  F,  Smith  in  a  paper  read  before  the  Na- 
tional Individualist  Club.  *'There  appear  to  have  been  some.  For 
example,  an  American  doctor  shaved  the  fur  from  some  animals  and 
placed  them  in  a  freezing  temperature.  They  caught  cold.  We 
learn  from  that  to  wear  warm  clothing  in  winter.  Frogs  have  been 
placed  in  boiling  water.  They  endeavour  to  escape,  showing  that 
pain  is  caused.  We  learn  that  we  should  avoid  bathing  in  boiling 
water,  .  .  .  etc.  But  here,  as  far  as  I  can  ascertain,  the  practical 
result  ceases.  .  .  ."  (See — "Vivisection,  An  Independent  Medical 
View,"  by  Dr.  Stephen  F.  Smith,  page  8,  London,  1898.) 

Agitators  from  the  ranks  of  the  laity  adduce  other  arguments  to 
prove  the  uselessness  of  vivisection.  "Vivisection  is  the  arch-enemy 
of  science,  whose  teaching  has  ever  been  that  Nature  is  one  in  es- 
sence, and  that  her  laws  are  harmonious  and  not  contradictory;  but 
if  her  laws  are  not  contradictory,  how  can  it  possibly  be  that  what  is 
morally  wrong  should  be  scientifically  right;  that  what  is  cruel  and 
unjust  should  eventually  lead  us  to  peace  and  health?  .  .  ."  (See 
p.  6,  "The  Sanctuary  of  Mercy,"  by  Mrs.  Mona  Caird,  1899.)  And 
this  Is  what  is  said  in  the  country  of  Darwin !  .  .  .  Sometimes  God 
is  substituted  for  Nature.  "I  believe  that  the  great  Orderer  of  all 
things  is  a  Righteous,  Holy,  Merciful  God;  and  such  a  God  could 
not  (I  say  it  with  all  reverence),  could  not  possibly  have  made  His 
world  as  that  man  should  be  obliged  to  seek  for  the  remedies  of  his 
diseases  by  tormenting  His  humbler  creatures.  I  think  it  is  a 
blasphemous  idea  that  such  should  be  God's  appointment." 

Thus  spoke  Miss  Cobbe,  upon  the  occasion  of  the  formation  of  the 
Welsh  Section  of  the  British  Union  for  the  Abolition  of  Vivisection 
in  1898.  (See  "Vivisection  Explained,"  p.  6.)  ...  And  so  on 
ad  tnf. 


152     THE  MEMOIRS  OF  A  PHYSICIAN 

only  ignorant,  or  very  unprincipled,  people  can  deny 
this.  The  foregoing  chapters  have  shown  how 
manifold  is  the  necessity  of  vivisection  in  our 
science. 

Previous  experiment  on  animals  furnishes  at  least 
a  partial  guarantee  that  a  murderous  dose  of  a  new 
drug  will  not  be  administered  to  the  patient,  that 
the  surgeon  will  not  attempt  an  operation  without 
previous  experience.  Further,  it  is  no  mere  co- 
incidence that  criminal  experiments  on  men  have 
been  perpetrated  most  frequently  in  the  province  of 
venereal  disease — from  which  the  lower  animals  are 
entirely  immune.  But  most  important  of  all  is  the 
fact,  that  without  vivisection  we  are  entirely  de- 
barred from  understanding  and  grasping  the  living 
organism.  Let  us  take  up  any  branch  of  physiology 
or  pathology  and  we  shall  see  that  nearly  everything 
of  any  importance  has  been  discovered  through  ex- 
periment upon  animals.  In  1883,  in  answer  to 
pressure  brought  to  bear  on  the  Prussian  Govern- 
ment by  anti-vivisectionist  agitators,  the  former  ap- 
plied to  the  medical  faculties  of  the  universities 
throughout  the  country,  with  enquiries  as  to  how  far 
vivisection  was  really  necessary. 

An  eminent  German  physiologist,  for  an  answer, 
sent  the  Government  Herrmann's  "Handbook  on 
Physiolog}^"  having  previously  struck  out  all  those 
facts  which  it  would  have  been  impossible  to  es- 
tablish without  recourse  to  vivisection.     According 


THE  QUESTION  OF  VIVISECTION     153 

to  the  German  newspapers,  "Herrmann's  book, 
thanks  to  such  annotations,  acquired  the  appearance 
of  a  Russian  newspaper  after  it  had  passed  through 
the  censor's  hands;  more  text  was  crossed  out  than 
left  untouched." 

It  is  impossible  to  understand  and  know  the  living 
organism  without  vivisection;  and  without  its  com- 
plete and  manifold  comprehension,  the  supreme  end 
of  medicine — the  succouring  of  the  sick — would  be 
unreliable  and  fallacious.  In  1895  the  well-known 
physiologist,  Prof.  T.  P.  Pavloff,  exhibited  before 
an  assembly  of  one  of  the  medical  societies  of  St. 
Petersburg,  a  dog  whose  nervus  vagus  had  been 
severed;  thanks  to  his  experiments  upon  this  dog, 
Pavloff  had  been  enabled  to  decide  several  highly 
important  questions  dealing  with  the  physiology  of 
digestion.  A  writer  in  the  Novoye  Vremja  vehe- 
mently attacked  the  professor  for  his  experiments. 

"By  whom  was  it  required,  and  to  what  end  neces- 
sary, to  sever  the  dog's  nervus  vagus ^  Has  actual 
life  ever  furnished  a  ease  which  could  have  sug- 
gested the  experiment  to  the  disciples  of  science*? 
This  is  an  extremely  sad  example  of  vivisectionist 
zeal  of  the  worst  and  most  unscientific  kind.  .  .  . 
This  is  a  case,  so  to  speak,  of  science  for  science's 
sake.  .  .  .  When  we  contemplate  these  fine  artifices 
resulting  from  the  straining  and  unnatural  ingenious- 
ness  of  the  vivisector  brotherhood,  in  juxtaposition 
with  the  fact  that  most  people  die  of  ordinary  colds, 


154    THE  MEMOIRS  OF  A  PHYSICIAN 

which  the  doctors  are  unable  to  cure,  the  raptures 
of  medical  societies  over  an  experiment  with  the 
nervus  vagus^  savour  uncommonly  of  sarcasm.  .  .  . 
They  do  not  know  how  to  cure  or  understand  the 
simplest  diseases,  and  at  the  same  time  this  vivi- 
sectionist  enthusiasm  is  assuming  threatening  dimen- 
sions, and  the  unwisdom  and  the  heartlessness  of 
the  sapient  butchers  who  stand  at  its  forefront  fills 
us  with  disgust." 

This  is  a  typical  argument  of  the  man  in  the 
street.  "Why  study  the  organism  in  all  its  func- 
tions if  one  cannot  cure  a  'simple'  cold'?"  Yes,  we 
persevere  in  these  researches  for  the  sake  of  learning 
how  to  cure  a  "simple"  cold  (which,  by  the  way, 
is  far  from  being  simple)  !  "This  is  science  for 
the  sake  of  science."  .  .  .  Science  is  only  then  sci- 
ence when  its  pursuit  is  unfettered  by  any  conditions 
erf  direct  practical  utility.  Electricity  remained  for 
a  long  time  but  a  "curious  natural  phenomenon,"  de- 
void of  all  practical  importance.  If  Grey,  Galvani, 
Faraday,  and  a  host  of  less  distinguished  investi- 
gators, had  not  been  guided  by  the  principle  of 
"science  for  the  sake  of  science,"  we  should  at  the 
present  day  have  neither  telegraph,  telephone,  Ront- 
gen  Rays,  nor  electro-motors.  The  chemist  Chev- 
reuil,  out  of  a  thirst  for  knowledge  purely  scientific, 
discovered  the  components  of  fatty  substances — 
which  resulted  in  the  manufacture  of  stearine  candles. 

However,  we  must  give  them  their  due;  far  from 


THE  QUESTION  OF  VIVISECTION     155 

all  the  anti-vivisectionists  base  their  opinions  upon 
such  crude  and  ignorant  tenets  as  these  just  ad- 
duced. A  number  of  them  seek  to  base  the  whole 
question  upon  foundations  of  pure  principle;  thus, 
for  instance,  the  English  anti-vivisectionist  Henry 
S.  Salt,  author  of  "Animals'  Rights  considered  in 
Relation  to  Social  Progress,"  says :  "Let  us  assume 
that  the  progress  of  Surgical  Science  is  assisted  by 
the  experiments  of  the  vivisector.  What  then? 
Before  rushing  to  the  conclusion  that  vivisection  is 
justifiable  on  that  account,  a  wise  man  will  take  into 
full  consideration  the  other— the  moral  side  of  the 
question — the  hideous  injustice  of  torturing  an  inno- 
cent animal."  This  is  the  only  possible  and  fitting 
position  for  the  anti-vivisectionist  to  take  up: 
whether  science  can  dispense  with  vivisection  or  not 
does  not  concern  him;  animals  are  made  to  suffer, 
and  that  settles  everything.  The  question  is  plainly 
put  and  there  can  be  no  room  for  any  equivocation. 
I  repeat,  that  we  ought  not  to  ridicule  the  preten- 
sions of  the  anti-vivisectionists — the  sufferings  of 
animals  are  truly  horrible — and  sympathy  with 
them  is  not  sentimentality;  but  we  must  bear  in 
mind  that  there  is  no  "way  round"  where  the  build- 
ing up  of  scientific  medicine — its  goal — the  healing 
of  mankind — is  at  stake. 

In  Western  Europe  the  enemies  of  vivisection 
have  already  obtained  considerable  restrictions  of  its 
freedom.     The  Cruelty  to  Animals  Act  passed  by 


156     THE  MEMOIRS  OF  A  PHYSICIAN 

the  British  Parliament  in  1876  may  be  considered 
the  most  important  of  such  legislative  measures. 
According  to  this  Act,  only  those  who  have  obtained 
a  special  licence  thereto,  have  the  right  to  experi- 
ment on  living  animals  (which  authorisation,  by  the 
way,  is  liable  to  be  withdrawn  at  any  moment).  In 
1885  ^^^  Austrian  Minister  of  Public  Education 
issued  certain  regulations,  according  to  which  "ex- 
periments on  living  animals  may  only  be  conducted 
in  the  interests  of  serious  investigation  and  only  in 
exceptional  cases  of  the  most  pressing  need." 

In  Denmark  permission  for  vivisection  is  necessary 
from  the  Minister  of  Justice  (!).  All  such  laws 
create  a  most  bizarre  impression.  To  whom  will 
such  licences  be  granted?  Naturally  to  eminent 
savants.  But  let  us  go  back  into  history  a  little. 
In  the  late  seventies,  in  the  obscure  little  German 
town  of  Wollstein,  a  then  entirely  unknown  doctor, 
Robert  Koch  by  name,  through  his  experiments 
upon  animals,  most  minutely  studies  the  biology  of 
the  bacillus  of  anthrax  and,  thanks  to  these  in- 
vestigations, opens  up  broad  prospects  for  the  newly- 
born  and  extremely  important  science  of  bacteriol- 
ogy. It  is  very  unlikely  that  that  obscure  provincial 
doctor  would  have  been  able  to  obtain  the  necessary 
licence.  .  .  .  To  go  into  the  question  further,  who 
is  to  decide  which  experiments  are  "necessary"  to 
science  and  which  are  not?  The  Minister  of 
Justice?     The  idea  is  preposterous!     The  learned 


THE  QUESTION  OF  VIVISECTION     157 

faculties'?  But  who  does  not  know  that  academical 
erudition  is  almost  invariably  a  staunch  adherent  to 
routine?  When  Helmholz  discovered  his  law  of 
conservation  of  energy,  the  Academy  of  Sciences — 
he  has  told  us  so  himself — dismissed  his  work  as 
one  consisting  of  "senseless  and  vacuous  reasonings." 
His  investigations  on  the  rapidity  of  transmission  of 
the  nervous  current  were  also  greeted  by  the  scepti- 
cal smiles  of  those  who  then  stood  at  the  head  of 
physiology. 

Has  the  anti-vivisectionist  agitation  any  chance 
of  success  in  the  future?  I  think  that  its  success 
has  been  hitherto  due  solely  to  the  ignorance  of  the 
public,  and  that  in  proportion  to  the  lessening  of 
that  ignorance  it  will  fall  further  and  further  in 
popular  estimation. 

The  Cruelty  to  Animals  Act  was  passed  by  the 
British  Parliament  in  August,  1876.  A  most  auspi- 
cious date!  It  was  just  at  that  time  that  the  Turks 
were  enacting  their  atrocities  in  Bulgaria,  encouraged 
by  the  friendly  non-interference  of  Great  Britain. 
Is  it  possible  that  the  frogs  and  guinea-pigs  experi- 
mented upon  in  the  laboratories  were  more  precious 
and  dear  to  tlie  members  of  Britain's  parliament, 
than  the  Bulgarian  women  and  children  outraged 
and  slaughtered  by  the  Bashibouzouki?  Of  course 
not.  The  explanation  is  far  simpler:  Parliament 
saw  that  intervention  in  Bulgaria's  cause  was  un- 
^rofitahle  to  England,  but  it  did  not  realise  the 


158    THE  MEMOIRS  OF  A  PHYSICIAN 

unprofitableness  of  placing  difficulties  in  the  way  of 
vivisection.  For  when  nothing  seems  to  threaten  his 
interests,  man  finds  it  easy  to  be  upright  and  humane. 
.  .  .  Russian  life  furnishes  us  with  still  more  vivid 
examples  of  such  seeming  inconsistency.  .  .  . 

When  men  comprehend  what  they  sacrifice  in 
depriving  science  of  the  right  of  vivisection,  the  anti- 
vivisectionist  agitation  will  be  doomed  to  a  natural 
death.  At  one  of  the  anti-vivisectionist  Congresses, 
the  Bishop  of  Manchester,  Dr.  Moorehouse,  declared 
that  he  would  "rather  die  a  hundred  times  than  save 
his  life  by  such  infernal  experiments"  as  those  in- 
flicted upon  vivisected  animals.  Only  the  most  in- 
significant minority  of  men  are  capable  of  such  con- 
scious self-sacrifice.  .  .  . 


CHAPTER  X 

THE    UNCERTAINTY    OF    DIAGNOSIS 

WHATEVER  be  the  physician's  limitations,  the 
health  and  life  of  man  are  entrusted  to  his 
custody. 

As  the  reader  will  recall  to  mind,  as  far  back  as 
the  closing  years  of  my  University  studies,  the  slip- 
pery, hard  and  dangerous  way,  which  the  imperfec- 
tions of  our  science  foredoomed  us  to  tread,  was 
disclosed  before  me.  One  day  our  Professor  of 
Gynsecology  entered  the  lecturing  theatre  with 
sombre  face,  evidently  upset  about  something. 

"Gentlemen !"  he  said,  "you  remember  the  woman 
suffering  from  endometritis,  whom  I  demonstrated 
before  you  ten  days  ago,  and  upon  whom  I  performed 
in  your  presence  erosion  of  the  uterus.  Yesterday 
she  died  of  septic  infection  of  the  peritoneum.  .  .  ." 

The  professor  minutely  detailed  before  us  the 
progress  of  the  disease  and  the  results  of  the  post- 
mortem examination.  Apart  from  the  abnormal 
development  of  the  mucous  membrane,  for  the  re- 
moval of  which  curetting  had  been  resorted  to,  it 
turned  out  that  in  the  thickness  of  the  uterus  a  so- 
called  myoma  was  in  existence — a  muscular  tumour. 

iS9 


i6o    THE  MEMOIRS  OF  A  PHYSICIAN 

Erosion  of  the  uterus,  in  the  presence  of  myoma,  is 
accompanied  by  grave  danger,  because  mortification 
readily  sets  in,  followed  by  purulent  decomposition. 
In  the  present  instance,  the  most  careful  inspection 
of  the  uterus  disclosed  nothing  to  lead  one  to  suspect 
the  presence  of  a  myoma.  Curetting  was  per- 
formed— which  resulted  in  the  patient's  death. 

"Thus,  Gentlemen,"  continued  the  professor, 
"there  can  be  no  doubt  that  the  patient's  death  was 
caused  by  our  operation;  without  it  she  might  have 
continued  to  live  for  years  and  years,  although  not 
without  suffering.  .  .  .  Unfortunately  our  science 
is  not  omnipotent.  It  is  well-nigh  impossible  to 
foresee  such  sad  eventualities  and  we  must  be  always 
prepared  for  them.  To  guard  against  such  errors, 
Schultze  recommends " 

The  professor  spoke  on  for  a  long  time,  but  I  had 
ceased  to  pay  attention  to  him.  His  words  seemed  to 
have  hurled  me  from  those  skies  whither  my  raptur- 
ous enthusiasm  in  the  progress  of  medicine  had  re- 
cently transported  me.  Our  professor,  I  mused,  was 
a  specialist  of  European  reputation,  with  talents  rec- 
ognised by  all,  and  nevertheless  he  was  not  certain  of 
avoiding  such  terrible  mistakes.  How  would  it 
fare  with  me,  one  of  the  herd,  in  future?  And  for 
the  first  time  that  future  loomed  up  before  me 
scowling  and  ominous.  I  felt  disconcerted  and 
crushed  by  the  immensity  of  the  responsibilities  that 
awaited  me  later  on.     Everywhere  I  found  confirma- 


UNCERTAINTY  OF  DIAGNOSIS      161 

tion  of  the  vastness  of  this  responsibility.  Taking 
up  a  copy  of  the  Therapeutic  News  one  day,  I 
chanced  upon  the  following  lines : — 

''Binz  communicates  a  case  of  abortion  that  took 
place  after  five  doses  of  natrium  salicylicum,  each 
one  gramme,  had  been  administered.  Arraigned  in 
court,  the  physician  who  had  prescribed  the  medicine 
was  acquitted,  on  the  ground  that  cases  such  as  the 
above  had  not  as  yet  been  published^  although,  as  is 
well  known,  the  employment  of  natrium  salicylicum 
is  largely  practised." 

This  paragraph  came  under  my  notice  accidentally 
— I  might  as  easily  have  passed  it  by  unread;  how- 
ever that  might  have  been,  henceforth,  if  anything 
of  the  kind  were  to  happen  to  me,  I  should  have  no 
excuse:  a  precedent  had  already  been  established. 
...  I  had  to  know  all,  remember  all,  be  able  to  do 
everything,  no  one  enquiring  whether  the  strength 
of  a  single  man  were  adequate  to  such  a  task  I 

But  my  buoyancy  of  spirit  soon  returned.  So 
long  as  I  remained  at  the  University,  no  responsi- 
bility weighed  me  down.  But  when,  as  a  full- 
fledged  doctor,  I  took  up  practice  and  became  cog- 
nisant of  the  limitations  of  my  powers,  in  actual  life, 
I  began  to  feel  myself  in  the  position  of  a  guide 
whose  duty  it  is  to  conduct  people  through  the  night 
along  the  slippery  and  crumbling  edge  of  a  precipice : 
they  trust  in  me  and  do  not  even  suspect  that  they 
are  on  the  brink  of  an  abyss,  while  I  am  ever  in  a 


i62     THE  MEMOIRS  OF  A  PHYSICIAN 

tremble,  lest  one  of  them  should  miss  his  footing  and 
topple  over  into  space. 

Often,  when  I  had  diagnosed  a  patient's  com- 
plaint, I  positively  could  not  make  up  my  mind  to 
start  treatment,  and  availed  myself  of  the  first  pos- 
sible pretext  to  abandon  the  case. 

One  day,  at  the  outset  of  my  practice,  a  woman 
suffering  from  tape-worm  came  to  me.  The  best 
and  most  efficacious  remedy  against  tape-worm  is 
extract  of  male  fern.  I  refreshed  my  memory  by 
looking  the  matter  up  in  my  text-books,  and  read 
the  following:  "The  remedy  {i.e.  extract  of  male 
fern)  lost  much  of  its  old  reputation,  because  it  was 
administered  in  too  small  doses.  .  .  .  But  in  pre- 
scribing, great  circumspection  must  be  exercised: 
large  doses  may  have  a  poisonous  effect."  Thus 
I  was  enjoined  to  exercise  '"great  circumspection" 
in  prescribing  the  only  efficacious  quantity,  which 
should  not  be  "too  small."  Under  these  conditions, 
how  on  earth  was  I  to  exercise  caution^  I  told  my 
patient  that  I  could  not  treat  her  and  that  she  had 
better  apply  to  another  medical  man. 

She  opened  her  eyes  wide. 

"I  will  pay  you,"  she  said. 

"Oh,  no,  you  misunderstand  me.  You  see.  .  .  . 
One  must  give  the  business  in  hand  one's  undivided 
attention,  and  at  present  I  lack  the  necessary 
leisure.  .  .  ." 

The   woman  shrugged  her  shoulders  and  went 


UNCERTAINTY  OF  DIAGNOSIS      163 

away.  In  the  beginning  I  experienced  the  same 
fears  in  the  presence  of  nearly  all  of  my  patients, 
and  my  apprehensiveness  was  further  increased 
through  the  sense  of  my  undoubted  inexperience: 
it  suffices  us  to  recall  the  case  of  the  washerwoman's 
son. 

But  as  time  slipped  by,  habit  developed  little  by 
little ;  I  ceased  to  be  afraid  of  every  little  thing  and 
my  self-reliance  grew.  I  no  longer  suffered  vain 
tortures  at  the  thought  of  all  manner  of  complica- 
tions every  time  I  prescribed  for  a  patient.  But 
nevertheless  that  sword  of  Damocles — the  possibility 
of  an  "unfortunate  accident,"  always  kept  me  in  a 
state  of  nervous  tension. 

One  never  knows  beforehand  whence  to  expect, 
and  where  to  look  for,  those  terrible  "unfortunate 
accidents."  I  remember  how  one  day  we  had  to 
perform  dissection  of  the  elbow  in  the  case  of  a 
young  girl  of  sixteen.  I  was  to  administer  the 
ansesthetic.  And  no  sooner  had  I  placed  the 
chloroform  mask  over  her  face,  hardly  had  she  drawn 
breath— one  single  inhalation  of  the  ansesthetic — 
than  her  visage  went  blue,  her  eyes  became  fixed  and 
her  pulse  vanished;  the  most  energetic  measures  of 
re-animation  proved  unavailing;  a  minute  before 
she  spoke,  was  agitated,  her  eyes  shone  with  fear 
and  life — and  now  she  was  a  corpse !  In  accordance 
with  the  parents'  wish,  an  official  post-mortem 
examination   of   the    deceased    was   held:    all    her 


i64     THE  MEMOIRS  OF  A  PHYSICIAN 

internal  organs  were  found  perfectly  sound — as 
examination,  previous  to  the  administering  of  chloro- 
form, had  shown;  notwithstanding  all  this — death 
had  resulted  from  that  terrible  "idiosyncrasy"  which 
is  the  surgeon's  bane  and  which  it  is  impossible  to 
foresee.  And  the  poor  child's  parents  removed  the 
body,  showering  curses  upon  us. 

I  passed  last  summer  in  an  out-of-the-way  village 
of  central  Russia.  One  day  I  was  asked  to  visit  a 
neighbouring  land-owner.  I  declined  to  do  so  point- 
blank,  for,  worn  out  by  over- work,  I  sought  but  one 
thing — complete  rest — to  see  no  more  suffering  faces, 
to  find  relief  for  my  over-wrought  nerves.  It  was 
quite  enough  when  the  peasants  applied  to  me,  for  I 
had  not  the  heart  to  turn  them  away. 

But  in  the  end,  of  course,  I  had  to  go.  The 
patient  was  a  quiet,  charming  old  man,  a  retired 
lieutenant-colonel  of  the  army,  with  white,  tobacco- 
stained  moustache;  he  suffered  from  cirrhosis  of  the 
liver  and  dropsy. 

"I  don't  expect  to  get  well,  Doctor,"  droned  the 
old  fellow  in  his  slow,  deep  voice.  "Time  I  quitted 
the  scene — one  ought  to  show  a  sense  of  decency. 
But  there's  such  a  lot  of  water  in  my  belly — ^just 
look  at  it — quite  a  hay-stack — I  can  hardly  breathe. 
My  doctor  taps  me  every  month,  but  he's  away  just 
now.  ...  So  I  took  the  liberty  of  bothering  you. 
I  have  all  the  necessary  instruments  in  the  house." 

In  such  cases  a  special  instrument,   a  so-called 


UNCERTAINTY  OF  DIAGNOSIS      165 

trocar,  is  used  for  the  tapping  of  the  liquid;  it  con- 
sists of  a  fine  straight  metal  tube  containing  a  keen- 
pointed  stiletto.  The  abdominal  walls  are  pierced 
by  means  of  the  trocar,  the  stiletto  is  withdrawn 
and  the  fluid  escapes  through  the  tube.  This  opera- 
tion is  entirely  without  danger :  if  the  instrument  be 
introduced  in  the  right  way,  no  wounding  of  the  in- 
testines is  possible.     I  let  the  liquid  out. 

A  month  later  the  old  man  sent  for  me  again. 
Once  more  I  made  the  puncture :  this  time  the  fluid 
was  weakly  tinted  with  blood;  probably  a  small 
vein  had  been  pierced.  Out  of  precaution  I  re- 
mained with  the  invalid  for  an  hour  or  so,  but  could 
detect  nothing  to  arouse  anxiety.  Early  next  morn- 
ing I  was  suddenly  summoned  to  the  patient.  Dur- 
ing the  night  a  rapid  change  for  the  worse  in  the  old 
man's  condition  had  taken  place;  he  lay  in  bed 
motionless,  deathly  pale,  with  waxen  face  and  barely 
stirring  pulse.  There  were  all  the  symptoms  of  an 
abundant  internal  haemorrhage.  While  I  was 
busied  in  preparing  a  physiological  saline  solution 
for  a  subcutaneous  injection,  the  patient  died.  It 
was  hard  to  say  what  had  really  happened.  I  was 
not  allowed  to  perform  autopsy;  the  most  likely 
thing  of  all  was,  that  the  sharp  point  of  the  trocar 
had  penetrated  an  abnormally  developed  and  senilely 
degenerated  branch  of  the  epigastric  artery,  which 
was  located  in  an  unusual  position,  and  that  during 
the  night  some  sharp  movement  of  the  patient's,  or 


i66     THE  MEMOIRS  OF  A  PHYSICIAN 

a  fit  of  coughing,  had  increased  the  flow  of  blood, 
which  had  been  but  insignificant  at  first. 

His  relatives  ascribed  the  old  man's  death  to  the 
natural  course  of  his  illness.  I  hated  to  keep  silent 
on  the  subject,  I  would  have  liked  to  tell  them  the 
truth,  to  explain  everything — but  what  end  could 
my  frankness  have  served'?  So  I  drove  off  home, 
without  enlightening  them. 

Quiet,  joyous  morning  lay  over  the  dewy  fields, 
the  sky  resounded  with  the  thrills  of  the  lark,  the 
trunks  of  the  slender  birches  stood  out  white  against 
the  delicate  green  of  the  woods — so  pure,  so  serene. 
.  .  .  Was  it  possible  that  nowhere  and  never  was  I 
destined  to  share  in  that  happy  untroubled  restful- 
ness? 

In  his  "Lectures  on  Calamities  in  Surgery,"  Sir 
James  Paget,  Bart.,  remarks:  "I  venture  to  say 
that  there  is  no  surgeon  in  large  practice,  no  surgeon 
to  a  large  hospital,  who  has  not  once  or  more  in  the 
course  of  his  life  shortened  patients'  lives  when  he 
was  making  attempts  either  to  prolong  them  or  to 
make  them  happier.  And  this,  you  will  observe,  is 
not  merely  the  case  with  capital  operations.  When 
a  patient  submits  to  a  capital  operation,  it  is  always 
in  order  to  remedy  something  that  will  render  his 
life  either  very  miserable  or  very  short;  and  to  escape 
such  distress,  it  is  quite  fair  that  a  man  should 
seriously -risk  his  life.  But  these  calamities  occur, 
however  rarely,  in  comparatively  trivial  cases,  when 


UNCERTAINTY  OF  DIAGNOSIS      167 

the  operation  is  not  done  for  any  consideration  of 
prolonging  life,  but,  it  may  be,  of  making  life  some- 
what happier,  or  somewhat  more  useful,  as  in  the 
amputation  of  a  finger,  the  tapping  of  an  ovarian 
cyst,  the  tapping  of  a  hydrocele,  the  division  of  a 
cervix  uteri.  ...  I  have  known  deaths  from  all 
of  these,  and  if  you  were  to  go  over  the  whole  list  of 
so-called  minor  operations,  you  would  find  that  every 
surgeon  of  much  experience  has  either  had  in  his 
own  practice,  or  known  in  that  of  others,  one  or 
more  cases  of  each  that  have  proved  fatal.  If  any 
man  will  remove  with  the  knife,  in  a  hundred 
instances,  cysts  from  the  scalp,  I  will  venture  to 
say  that  he  will  have  one  or  two  deaths.  If  any 
man  will  take  in  succession  an  equal  number  of 
cases  of  ligation  of  haemorrhoids,  the  probability  is 
that  he  will  have  one  or  two  deaths."  .  .  . 

Nothing  can  save  us  from  this. 

A  catastrophe  may  overwhelm  you  at  any  moment 
and  ruin  you  for  life.  In  1884,  Dr.  Spitzer,  a 
Viennese  physician,  attended  a  girl  of  fourteen, 
whose  fingers  had  been  frost-bitten;  he  prescribed 
collodion  with  iodine  and  gave  directions  that  it 
should  be  applied  to  the  frost-bitten  parts;  the 
child's  little  finger  mortified  and  had  to  be  ampu- 
tated. The  patient's  mother  sued  Dr.  Spitzer. 
The  defendant  was  mulcted  in  damages  to  the 
amount  of  650  Guldens,  condemned  by  the  Court  to 
a  fine  of  200  more  and,  in  addition,  deprived  of  his 


i68     THE  MEMOIRS  OF  A  PHYSICIAN 

right  of  practice.  The  papers  savagely  attacked 
Spitzer,  showering  him  with  gibes  and  loading  him 
with  ridicule.  This  aroused  great  excitement  in  the 
medical  world.  Spitzer  had  no  grounds  whatever 
to  expect  that  the  application  of  innocent  collodion 
with  iodine  could  have  such  a  destructive  action. 
The  defendant  appealed  to  the  Senate.  The  opinion 
of  the  Medical  Faculty  was  called  into  request. 
Relying  upon  a  report  dealing  with  the  subject 
drawn  up  by  the  eminent  surgeon,  Professor  Albert, 
the  Faculty  unanimously  declared  itself  as  follows: 
"The  application  of  collodion-with-iodine-ointment, 
as  employed  by  Dr.  Spitzer,  did  not  result  in 
gangrene  in  a  series  of  experiments  especially  con- 
ducted by  the  Faculty.  Neither  science  nor  litera- 
ture furnish  us  with  any  indications  pointing  to  the 
danger  of  employing  the  above  remedy  in  general, 
and  in  cases  such  as  that  under  consideration  in  par- 
ticular. Therefore  no  grounds  exist  for  accusing 
Dr.  Spitzer  of  incompetence." 

But  Spitzer  stood  in  no  further  need  of  this 
acquittal.  On  the  very  day  that  the  Faculty's 
verdict  was  made  public,  his  body  was  recovered 
from  the  Danube:  he  had  drowned  himself,  unable 
to  support  the  weight  of  this  universal  condemnation. 

Expect  mercy  of  no  one  in  such  circumstances! 
A  doctor  must  be  a  god,  infallible,  superior  to  doubt, 
to  whom  all  is  clear  and  all  is  possible.  And  woe 
to  him  if  it  be  otherwise,  if  he  make  a  mistake,  even 


UNCERTAINTY  OF  DIAGNOSIS     169 

though  it  were  humanly  impossible  not  to  err.  .  .  . 
About  fifteen  years  ago  a  "feuilleton"  writer  in  the 
Petersburg  Gazette  gave  wide  publicity  to  the  fol- 
lowing "revolting"  case  that  took  place  in  the  surgi- 
cal clinic  of  Professor  Kolomnin.  A  boy,  Kharito- 
noff  by  name,  "with  a  pain  in  the  hip-joint,"  was 
brought  by  his  parents  to  the  hospital;  while  being 
examined  by  the  assistant  house-surgeon,  Dr.  T.  (the 
name  was  given  in  full),  this  is  what  took  place: 
"T,  requested  JCharitonoff  to  jump  on  his  injured 
leg ;  the  patient  declined  to  do  so,  assuring  the  worthy 
medico  that  he  could  not  stand  on  the  affected  limb. 
But  the  ^sculapius  gave  no  heed  to  the  wretched 
youth's  words  and,  with  the  assistance  of  those  pres- 
ent, made  him  jump.  He  did.  A  terrible  cry  rang 
out  and  the  unhappy  boy  fell  into  the  arms  of  his 
executioners:  the  bone  had  broken  short  off  at  the 
hip."  The  patient  developed  sarcoma  "with  fright- 
ful rapidity"  and  died  "owing  to  the  fault  of  his 
torturers." 

Dr.  T.  explained  the  true  circumstances  of  the 
affair  in  a  letter  to  the  editor.  The  boy  complained 
of  pains  in  the  joint,  but  there  were  no  external 
indications  of  any  such  affection;  but  there  was 
reason  to  suspect  tuberculosis  of  the  hip-joint.  The 
patient  Kharitonoff  could  stand  on  the  disease  leg. 
"I  asked  the  patient  to  stand  on  the  affected  leg  and 
to  jump  slightly.  This  test,  in  cases  of  hip-disease 
in  its  initial  stages,  when  all  other  symptoms  are 


170    THE  MEMOIRS  OF  A  PHYSICIAN 

absent,  betrays  the  presence  of  the  disease  by  a  slight 
pain  in  the  joint."  Fracture  resulted.  Such  frac- 
tures belong  to  the  category  of  so-called  spontaneous 
fractures.  As  it  afterwards  transpired,  the  boy  was 
suffering  from  sarcoma  of  the  bone-marrow;  it  had 
corroded  the  bone  from  the  inside  and  destroyed 
its  normal  hardness;  the  first  violent  movement 
sufficed  to  cause  fracture ;  it  would  have  occurred  in 
any  case,  whether  at  the  hospital  or  on  the  patient's 
way  home.  "To  diagnose  such  disease,  when  the 
tumour  itself  cannot  be  found,  is  difficult  in  the  high- 
est degree,  and  sometimes  positively  impossible^' 
We  may  here  add  that  the  disease  just  described  be- 
longs to  the  number  of  very  rare  affections,  as  com- 
pared with  coxitis,  which  is  exceedingly  prevalent. 
Dr.  T.'s  explanation  called  forth  further  con- 
tumely on  the  "feuilletonist's"  part.  "Do  you  not 
find  it  most  wonderful  I"  he  wrote.  "A  spontaneous 
fracture!  ...  Is  not  this  the  apogee  of  untoward 
coincidence,  especially  for  us  lay  folks,  whose  lot  it 
is  to  hear  for  the  first  time  of  spontaneous,  self- 
acting,  automatic  fractures  of  arms  and  legs^  Only 
these  extraordinary  cases  enable  us  to  appraise  science 
at  its  true  valuation,  and  move  us  to  bitter  tears  at 
our  own  ignorance.  .  .  .  What  are  the  uninitiated 
to  do?  Of  course  not  argue  with  science !  All  that 
remains  us  is  to  hide  our  diminished  heads  in  the 
glorious  presence  of  science  and  to  assure  ourselves 


UNCERTAINTY  OF  DIAGNOSIS      171 

without  delay  (through  violent  contact  with  any 
hard  object),  quaking  the  while,  that  this  species  of 
treacherous  spontaneous  fracture  has  not  singled  us 
out  unawares  as  its  victims."  And  for  an  entire 
week  Dr.  T.  ran  the  gauntlet  of  universal  newspaper 
ridicule. 

It  is  easy  enough  for  outsiders  to  wax  indignant 
at  such  mistakes  of  the  faculty.  The  tragedy  of 
our  position  lies  therein,  that  were  such  a  case  to 
present  itself  to  any  of  us  the  day  following,  we 
should  be  in  duty  hound  to  act  in  exactly  the  same 
manner  as  just  described.  Of  course  the  choice  of  a 
much  easier  course  were  open ;  no  external  symptoms 
of  injury  to  the  joint  are  in  evidence;  there  is  a  way 
of  finding  out  whether  the  trouble  be  tubercular;  but 
what  if  the  affection  proved  to  be  sarcoma  of  the 
bone  and  a  fracture  were  to  result?  Truly,  sarcoma 
of  the  bone  is  so  rare  that  an  ordinary  doctor  is 
liable  to  come  across  it  three  or  four  times  during 
his  entire  practice;  it  is  no  less  true  that  if  treatment 
of  the  tubercular  joint  be  taken  in  hand  without 
delay,  every  hope  exists  for  a  complete  and  durable 
cure ;  but  nevertheless  .  .  .  nevertheless,  better  steer 
clear  of  rocks;  better  let  the  patient  return  home 
and  come  again  when  undoubted  external  symptoms 
have  made  their  appearance.  .  .  .  The  coward  who 
would  act  thus  were  unworthy  of  the  name  of 
doctor  I 


172     THE  MEMOIRS  OF  A  PHYSICIAN 

The  views  on  medicine  held  by  society  are  very 
erroneous — here  lies  the  main  reason  of  the  public's 
unjust  attitude  towards  the  profession.  Society 
ought  to  familiarise  itself  with  the  scope  of  the 
powers  vested  in  the  physician,  and  not  blame  him 
for  that  which  is  the  result  of  the  imperfection  of 
medical  science.  If  we  were  once  to  arrive  so  far, 
the  demands  on  doctors  would  be  lowered  to  a  rea- 
sonable level. 

However,  on  reflection,  I  doubt  somewhat  that 
this  would  happen.  Feeling  lacks  logic  and  declines 
to  countenance  it.  This  was  confirmed  quite  re- 
cently by  personal  experience.  My  wife  was 
brought  to  bed,  and  labour  being  very  difficult,  an 
operation  had  become  necessary.  All  the  accidents 
that  might  be  possible  under  the  circumstances  sud- 
denly loomed  up  before  me  with  cruel  vividness. 

"We  must  operate,"  the  accoucheur  said  to  me 
with  the  utmost  sang  froid^  in  his  everyday  tone. 

How  could  he  speak  of  such  a  thing  so  coolly^ 
Why,  he  knew  how  numerous  were  the  hazards  which 
threaten  the  mother  during  these  operations;  allow- 
ing even  that  such  occurrences  were  rare,  still  they 
existed  and  were  possible.  Yes,  I  felt  that  he  ought 
to  clearly  realise  what  the  loss  of  my  Natasha  would 
mean  to  me,  he  ought  to  be  absolutely  sure  of  per- 
forming the  operation  successfully.  Otherwise  the 
whole  thing  was  too  terrible  to  contemplate.  And 
there  could  be  no  excuse  for  him,  neither  for  him  nor 


UNCERTAINTY  OF  DIAGNOSIS      173 

for  science,  if  he  failed.  No,  he  dared  not  fail!  I 
was  entirely  carried  away  by  this  feeling  and  all  the 
reasonings  of  my  intellect  and  knowledge  were 
powerless  to  affect  me  in  the  least. 


CHAPTER  XI 

DOCTOR   AND    PATIENT 

I  HAVE  already  had  frequent  occasion  to  remark 
upon  the  strong  distrust  of  the  Dublic  mind 
towards  medicine  and  doctors. 

Since  time  immemorial  doctors  have  been  the 
favourite  butt  for  caricature,  epigram  and  anecdote. 
The  healthy  speak  of  medicine  and  the  faculty  with 
a  smile,  the  infirm  who  have  not  derived  benefit 
from  its  ministrations  criticise  it  with  unmeasured 
hatred.  These  sneers  and  this  distrust  disconcerted 
me  a  great  deal  while  I  was  a  novice.  I  felt  that, 
at  the  bottom,  both  were  well-merited,  for  there  was 
no  denying  that  our  science  contained  much  of  which 
we  well  might  be  ashamed.  Under  the  influence  of 
this  feeling,  in  moments  of  expansiveness,  I  occasion- 
ally felt  inclined  to  ventilate  my  poor  opinion  of, 
and  contemptuous  attitude  towards,  medicine. 

One  evening  while  staying  in  the  country,  I  was 
returning  home  from  a  stroll,  when  a  peasant  woman 
came  up  and  begged  me  to  examine  her  and  give 
her  some  physic.  I  entered  her  cottage,  accom- 
panied by  my  cousin.  The  woman  complained  of 
heart-burn,   flatulency   and   vertigo,   whenever  she 

174 


DOCTOR  AND  PATIENT  17^ 

stooped.  So  I  examined  her  and  told  the  good 
woman  to  come  round  later  on  for  some  drops  that 
I  would  give  her. 

"What  was  the  matter'?"  asked  my  cousin,  when 
we  had  left. 

"How  do  I  know*?"  was  my  smiling  rejoinder. 

"Now,  that's  funny  I  The  assurance  of  your 
manner  led  me  to  believe  that  you  saw  what  was 
the  matter  at  a  glance." 

"I'll  examine  her  again  in  a  day  or  two — ^perhaps 
then  I  will  be  able  to  tell  what  ails  her." 

"Dear,  dear  me!     So  much  for  your  science  I" 

"Oh,  yes,  our  science  is  pretty  exact,  as  you  see, 
isn't  it'?"  I  remarked.  And  I  started  on  a  recital 
of  numerous  cases  which  demonstrated  further  this 
"exactness"  and  illustrated  the  naive  way  in  which 
patients  looked  up  to  us  doctors. 

This  was  by  no  m^eans  the  only  occasion  upon 
which  I  spoke  of  medicine  in  the  same  strain.  Still, 
notwithstanding  the  undoubted  truth  of  what  I  said, 
those  conversations  invariably  left  me  with  a  feeling 
of  shame.  Whenever  I  gave  voice  to  such  senti- 
ments, for  the  time  being  I  adopted  the  standpoint 
of  my  listener  in  my  appraisement  of  the  facts,  but 
quand  meme^  at  bottom  my  attitude  towards  medi- 
cine was  both  earnest  and  full  of  reverence.  Clearly 
a  deep  misunderstanding  underlay  this.  Medicine 
does  not  justify  all  the  expectations  that  are  placed 
upon  it,  and  it  is  derided  and  discredited  in  conse- 


176     THE  MEMOIRS  OF  A  PHYSICIAN 

quence.  But  are  such  expectations  either  just  or 
legitimate'?  A  science  dealing  with  the  cure  of  dis- 
ease, which  we  style  medicine,  is  supposed  to  exist; 
those  who  have  studied  it  are  expected  to  recognise 
at  a  glance  and  to  cure  all  illnesses  forthwith  and 
without  fail.  If  they  cannot  do  this,  either  they 
must  be  incompetent,  or  else  their  science  is  a  fraud 
and  a  delusion.  Nothing  could  be  more  natural 
and,  at  the  same  time,  more  mistaken,  than  such  a 
view.  A  science  answering  more  or  less  to  the  ideal 
of  perfection  and  completeness,  whose  business  it 
were  to  cure  disease,  is  non-existent.  Such  as  it  is, 
medicine  is  confronted  by  the  human  organism  in  its 
endlessly  complex  and  involved  life;  we  have  ar- 
rived at  understanding  much  of  that  life,  but,  at  the 
same  time,  each  new  discovery  unravels  further 
before  us  its  miraculous  intricacy.  Many  diseases 
develop  in  the  system  through  dark  paths  that  we 
can  but  ill  follow;  obscure  and  intangible  are  the 
combative  powers  of  the  human  body ;  no  means  are 
known  by  which  these  forces  can  be  sustained;  there 
are  other  diseases  more  or  less  intelligible;  but  time 
out  of  number  they  run  their  course  so  secretly  that 
science,  with  all  the  means  at  its  disposal,  is  power- 
less to  detect  them.  Does  this  signify  that  doctors 
are  superfluous  and  that  their  science  is  utterly  bank- 
rupt*? But  we  must  not  forget  that,  on  the  other 
hand,  there  is  much  else  that  is  actually  within  their 
ken;  the  field  where  the  physician  can  dispense  con- 


DOCTOR  AND  PATIENT  177 

Crete  help  is  sufficiently  vast.  No  doubt  he  is  often 
powerless  to  give  relief,  but  a  doctor  alone  is  com- 
petent to  judge  of  this — not  the  patient.  Even 
when  in  the  presence  of  such  a  case,  the  physician  is 
invaluable — were  it  but  for  the  reason  that  he  real- 
ises the  complexity  of  the  morbid  process,  whereas 
neither  the  patient  nor  his  entourage  are  able  to  un- 
derstand it. 

People  lack  even  the  faintest  idea  either  of  the 
life-processes  of  their  bodies  or  the  powers  and 
remedies  at  the  command  of  medical  science. 

From  this  spring  the  great  majority  of  such  mis- 
understandings; here  lies  the  cause  both  of  blind 
faith  in  the  omnipotence  of  m_edicine  and  of  the  blind 
disbelief  in  its  efficaciousness.  Both  lead  to  equally 
disastrous  results.  All  manner  of  popular  medical 
books  and  pamphlets  are  disseminated  amongst  the 
public.  Every  family,  pretending  to  more  or  less 
education,  invariably  possesses  a  medicine  chest,  and 
before  the  doctor  is  called,  the  patient  is  sure  to  have 
been  consecutively  dosed  with  castor  oil,  quinine  or 
salicylic  acid.  If  people  possessed  a  reasonable 
understanding  of  elementary  medical  science,  instead 
of  blind  faith,  nothing  of  the  kind  would  be  possible. 
It  would  then  be  recognised  that  every  new  patient 
represented  a  novel  and  unique  illness,  highly  com- 
plicated and  involved,  which  even  a  doctor,  with  all 
his  knowledge,  often  finds  it  difficult  to  understand 
fully, 


178     THE  MEMOIRS  OF  A  PHYSICIAN 

Suppose  that  a  member  of  the  family  be  consti- 
pated— he  is  given  castor  oil.  Would  any  one  dare 
venture  upon  such  treatment  if  he  or  she  so  much  as 
suspected  that  sometimes  a  man  may  be  killed  by  this 
m.eans;  that  occasionally,  for  example  in  cases  of 
saturnine  colic,  constipation  cannot  be  relieved  by 
castor  oil,  but  only  by  .  .  .  opium? 

The  exaggerated  demands  made  of  medicine, 
founded  upon  an  ignorant  belief  in  its  omnipotence, 
are  the  physician's  bane  and  fetter  him  hand  and 
foot.  A  patient  ill  with  typhoid  suffers  from  high 
fever,  splitting  headaches,  night  sweats;  he  is  op- 
pressed by  delirium;  these  must  be  fought  against 
with  great  precautions,  natural  remedies  being 
chiefly  recoursed  to;  but  tell  the  patient  that  he  must 
suffer,  bathed  in  perspiration  and  tormented  by  hal- 
lucinations, he  will  turn  from  you  and  apply  to  a 
medical  man  who  will  not  stint  him  in  quinine, 
phenacetin  and  chloral.  He  says:  "What  doctor 
is  this  who  does  not  alleviate  the  patient's  pain*?" 
No  matter  that  this  assuagement  is  bought  at  the 
price  of  the  patient's  strength :  let  the  permanent  ruin 
of  his  constitution  be  the  result,  let  him  lose  for  all 
days  the  power  to  combat  disease  independently;  his 
pain  was  soothed,  and  that  sufficed  in  itself.  The 
most  miserable  patients  in  this  respect  are  various 
"exalted  personages" — impatient  and  spoilt,  who 
blame  the  doctor  for  the  slightest  malaise^  even  when 
it  is  impossible  to  remove  it,     This  explains  why 


DOCTOR  AND  PATIENT  179 

many  doctors,  of  whom  their  colleagues  speak  with 
contempt,  and  to  whom  no  medical  man  in  his  right 
senses  would  ever  dream  of  applying,  enjoy  the  great- 
est popularity  with  a  certain  section  of  the  public. 

People  say  that  a  doctor  is  a  doctor  who  is  able  to 
ease  pain  and  cure  diseases  with  facile  confidence; 
but  actuality  contradicts  such  an  idea  at  every  step, 
and  those  who  had  hitherto  blindly  believed  in 
medicine,  cast  themselves  into  the  other  extreme. 
Suppose  that  the  patient  suffers  from  a  curable 
complaint,  but  one  requiring  long  and  S5^stematic 
treatment;  a  week  or  two  pass  by  without  any 
appreciable  improvement,  and  the  patient  throws 
over  his  medical  adviser  and  applies  to  a  quack. 
There  are  certain  protracted  diseases  for  which  no 
efBcacious  remedies  exist — -for  instance,  whooping- 
cough;  the  doctor  who  has  been  requested  to  treat 
this  illness  in  a  family  for  the  first  time,  may  rest 
assured  that  his  services  will  never  again  be  in 
demand  in  that  quarter.  All  that  the  physician  can 
do  is  to  keep  an  eye  on  the  hygienic  conditions, 
and  be  on  the  alert  to  meet  any  possible  complica- 
tions ;  and  it  requires  either  deep  and  tried  confidence 
in  the  doctor,  or  else  full  understanding,  to  become 
reconciled  to  his  passive  role. 

But  the  richest  soil  of  all  for  the  flourishing  of 
this  negation  of  mxcdicine,  is  furnished  by  the  pro- 
fession's mistakes.  A  doctor  diagnoses  a  disease  as 
typhoid,  while  autopsy  discloses  general  tubercular 


i8o    THE  MEMOIRS  OF  A  PHYSICIAN 

infection — shame  upon  the  faculty! — although  the 
clinical  picture  of  both  is  often  identical.  I  number 
among  my  acquaintances  a  man  who  has  suffered 
for  three  years  from  severe  pains  in  the  knee:  one 
doctor  diagnosed  tuberculosis,  another  syphilis,  a 
third  the  gout;  and  neither  of  the  three  afforded 
him  any  relief. 

Of  course,  this  only  shows  that  very  often  the 
manifestations  of  a  disease  are  so  obscure  and  vague, 
that  we  have  to  depend  on  chance  alone  for  hitting 
upon  the  right  diagnosis.  But  personal  experience 
is  all  to  the  individual,  and  my  friend  says :  "Your 
profession  is  as  necessary  to  mankind  as  a  neck-tie; 
although  entirely  useless,  conventional  decency  re- 
quires that  the  civilised  man  should  wear  one.  Ac- 
cordingly, he  uncomplainingly  spends  money  on 
cravats,  and  those  who  earn  their  living  by  making 
them  imagine  that  they  are  performing  useful 
work.  ..." 

"I  confess  to  you,  Doctor,  that  I  entirely  dis- 
believe in  your  medicine,"  a  lady  remarked  to  me 
the  other  day. 

She  disbelieves  in  medicine.  .  .  .  But  she  is  abso- 
lutely ignorant  of  the  subject!  How  can  one  be- 
lieve or  disbelieve  in  the  importance  of  what  one 
knows  nothing  about? 

A  great  deal  of  what  I  have  said  in  the  foregoing 
chapters  may  breed  scepticism  in  persons  whose 
faith  in  medicine  had  hitherto  been  blind.     I  ex- 


DOCTOR  AND  PATIENT  181 

perienced  this  scepticism  myself,  and  lived  it  down. 
Now,  knowing  all,  I  exclaim  with  conviction:  *'I 
believe  in  medicine !"  I  believe  in  it,  in  the  face  of 
its  limitations.  How  could  my  attitude  be  other, 
when  every  day  of  my  life  my  training  enables  me 
to  save  my  fellow-creatures  from  death,  when  hourly 
I  see  how  those  who  renounce  medicine  compass 
their  own  ruin'? 

"I  don't  believe  in  your  medicine  I"  says  my  lady 
friend.  Perhaps  it  were  as  well  to  go  to  the  root 
of  the  matter  and  find  out  what  she  really  does 
believe  in! 

That  it  is  possible  to  stop  whooping-cough  in  a 
couple  of  days,  or  that  the  timely  application  of 
atropin,  in  certain  ocular  affections,  can  preserve 
a  man's  sight?  Neither  in  a  couple  of  days  nor  a 
couple  of  weeks  is  it  possible  to  stay  the  natural 
course  of  whooping-cough,  but  a  few  drops  of  atropin 
may  save  a  man  from  blindness,  and  he  who  "dis- 
believes" in  such  truths  is  on  the  same  mental  plane 
as  the  sceptic  who  is  incredulous  that  there  should  be 
parts  of  the  world  where  the  peasants  speak  French. 

A  man  suffers  for  long  years  from  asthma:  I 
cauterise  his  nasal  conchils  and  he  becomes  well, 
happy  in  the  consciousness  of  his  health.  A  boy  is 
slow  and  inattentive,  lacks  memory:  I  remove  his 
hypertrophic  tonsils,  and  mental  transfiguration 
results.  A  child  is  exhausted  by  diarrhcea;  without 
any  medicine,  simply  by  regulating  its  diet  and  the 


i82     THE  MEMOIRS  OF  A  PHYSICIAN 

hours  of  its  meals,  I  bring  it  back  to  plump  health 
and  high  spirits.  Often  my  knowledge  enables  me 
to  ward  off  a  serious  illness  by  the  timely  prescrip- 
tion of  the  most  trivial  dose  of  physic,  the  applica- 
tion of  the  simplest  treatment.  And  the  more 
profound  the  popular  ignorance,  the  more  vividly 
does  the  importance  of  my  knowledge  stand  out. 
In  those  difficult  and  involved  cases  which  required 
the  expenditure  of  a  large  amount  of  mental  and 
nervous  force,  the  enjoyment  of  the  sweets  of 
triumph  was  especially  keen,  and  one  fully  realised 
the  absurdity  of  the  idea  that  it  would  have  been 
possible  to  accomplish  anything  without  scientific 
training.  .  .  .  No,  I  repeat  that  I  believe  in  medi- 
cine, and  I  deeply  pity  those  who  do  not. 

The  jeers  at  its  expense  are  born  of  its  deriders' 
ignorance.  Still,  there  is  no  denying  that  in  many 
cases  we  are  impotent,  ignorant,  and  even  dangerous, 
although  the  fault  is  not  ours;  but  it  is  just  this 
seeming  contradiction  which  breeds  unbelief  in  our 
science  and  gives  rise  for  this  ridicule  of  ourselves. 

These  jeers  and  this  distrust  being  unjustified  and 
unreasonable,  the  question  naturally  arose:  what 
should  my  attitude  be  towards  my  patients^  Of 
course,  honesty  in  my  dealings  with  them  should  be 
my  first  consideration.  It  was  just  because  we  our- 
selves withhold  from  them  the  true  extent  of  the 
knowledge  at  our  command  that  the  hostile  and 
ironical  feeling  towards  ourselves,  which  we  invari- 


DOCTOR  AND  PATIENT  183 

ably  arouse,  is  made  possible.  One  of  Tolstoy's 
chief  artistic  merits  lies  in  his  strikingly  human  and 
earnest  treatment  of  every  one  of  the  types  he  paints ; 
he  makes  but  one — a  notable  exception  to  this  rule 
—when  he  deals  with  doctors;  Tolstoy  cannot 
describe  them  without  irritation  and  an  almost 
Turgenev-like  wink  to  the  reader.  Evidently  there 
is  something,  an  indefinable  "something"  which 
prejudices  us  in  all  eyes.  And  I  fancied  that  it 
must  be  this  cloaking  of  ourselves  in  a  kind  of 
nebulous  mantle  of  mystery,  the  exaggerated  con- 
fidence and  expectation  that  we  excite  towards  our- 
selves. Plainly  this  had  to  be  remedied.  But  life 
lost  no  time  in  upsetting  such  a  notion.  Things 
could  not  be  changed.  Here  is  an  example.  I 
attended  a  certain  government  clerk,  suffering  from 
typhoid;  he  was  constipated,  his  abdomen  was 
greatly  distended.  I  prescribed  calomel  in  the  usual 
laxative  dose  and  with  all  the  customary  precautions. 

"Doctor,  some  sort  of  complication  has  set  in  in 
my  husband's  mouth,"  his  wife  said  to  me,  when  I 
paid  my  next  call. 

The  patient  complained  of  an  abundant  secretion 
of  saliva,  his  gums  were  red  and  swollen,  his  mouth 
emitting  a  disgusting  odour;  everything  indicated 
the  typical  symptoms  of  a  slight  mercurial  poisoning 
caused  by  the  calomel  I  had  prescribed.  No  reason 
existed  for  the  slightest  self-accusation.  I  had 
taken  absolutely  every  measure  of  precaution. 


l84    THE  MEMOIRS  OF  A  PHYSICIAN 

What  could  I  say?  Was  I  to  tell  them  that  tak- 
ing my  medicine  was  the  cause"?  Nothing  could 
have  been  more  idiotic.  For  I  would  merely  have 
shattered  my  patient's  confidence,  no  useful  end 
being  attained  thereby,  and  in  future  he  would  an- 
ticipate some  catastrophe  from  my  every  prescrip- 
tion. So  I  wisely  held  my  peace,  evading  the  eye 
of  the  patient's  wife,  and  listened  to  her  remarks 
upon  the  wonderful  variety  of  complications  in 
typhoid  with  unruffled  composure. 

Another  time  I  was  called  to  attend  a  child  that 
had  suddenly  been  taken  ill;  it  was  feverish  but 
made  no  complaints,  nor  were  there  any  definite 
symptoms  present;  nothing  could  be  done  until 
further  developments  showed  themselves.  I  did  not 
care  to  prescribe  ut  aliquid  fiat^  so  I  told  the  mother 
that  certain  general  hygienic  measures  should  be 
taken,  but  that  no  medicines  were  necessary.  The 
child  developed  meningitis  and  died,  the  mother 
bitterly  blaming  me  for  its  death,  because  I  had  not 
"stopped"  its  illness  in  time. 

Again,  could  I  "be  honest"  with  incurables?  In 
their  case  it  is  ever  necessary  to  play  the  hypocrite, 
and  to  lie;  one  has  to  tax  one's  ingenuity  again  and 
again  in  making  up  all  sorts  of  fictions,  so  as  to 
sustain  the  sufferer's  drooping  spirits.  The  patient 
is  conscious  of  the  deception — at  least  to  a  certain 
extent — and  regards  the  doctor  with  sentiments  of 
indignation — ^he  would  like  to  relegate  medicine  to 


DOCTOR  AND  PATIENT  185 

the  blackest  depths  of  hell.  .  .  .  How  should  one 
comport  oneself  under  the  circumstances'?  ...  In 
such  matters  the  ancient  medicine  of  India  was  sin- 
cere and  cruelly  frank:  it  only  busied  itself  with 
hopeful  cases ;  the  incurable  had  no  right  to  its  min- 
istrations; his  relatives  conducted  him  to  the  banks 
of  the  Ganges,  filled  his  nostrils  and  mouth  with 
the  sacred  mud  and  cast  him  into  the  river.  .  .  . 

The  invalid  loses  his  temper  when  the  doctor  does 
not  tell  him  the  truth.  Oh!  all  that  he  wants  to 
know  is  the  truth  I  At  first  I  was  naive  and  youth- 
fully direct  enough  to  acquiesce  when  the  patient 
was  persistent;  only  little  by  little  did  I  realise 
what  was  really  meant,  when  he  desired  to  know 
the  truth,  declaring  that  he  did  not  fear  death. 
The  real  interpretation  of  such  words  was  to  be 
read  thus:  "If  there  be  no  hope,  lie  to  me  with 
skill,  that  I  should  not  doubt  the  truth  of  your 
words  for  a  moment." 

It  is  necessary  in  medical  practice  to  be  an  actor 
everywhere  and  at  every  step.  This  is  of  the  last 
importance  because  disease  is  not  only  cured  by 
medicines  and  special  treatment,  but  by  the  patient's 
spirits  as  well;  a  cheerful  and  hopeful  mood  is  an 
immensely  powerful  factor  in  the  struggle  against 
sickness,  and  its  importance  cannot  be  over-esti- 
mated. The  patients  whom  I  attended  habitually, 
who  warmly  believed  in  me  and  would  summon  me 
from  the   other   end   of  the   town,   derived   much 


i86    THE  MEMOIRS  OF  A  PHYSiaAN 

greater  benefit  from  my  treatment  than  those  who 
applied  for  the  first  time;  and  in  the  beginning  this 
was  a  source  of  surprise,  for  I  merely  saw  an  amus- 
ing coincidence  in  the  fact.  It  was  only  by  degrees 
that  it  dawned  upon  me  that  this  was  no  sport  of 
chance,  that  I  was  really  powerfully  reinforced  by 
the  confidence  I  had  won :  the  energy  of  both  patient 
and  his  entourage  was  wonderfully  buoyed  up 
thereby.  The  sick  stand  in  pressing  need  of  this 
faith,  detecting  with  fine  instinct  any  note  of  doubt 
or  vacillation  in  the  doctor's  voice. 

And  in  the  sick-room  a  deportment  breathing  calm 
confidence  came  to  me  as  a  second  nature;  I  issued 
my  orders  in  an  authoritative  tone,  brooking  no 
contradiction,  although  a  thousand  doubts  might  be 
assailing  me  internally. 

''Wouldn't  it  be  better  to  try-—"?"  queries  the 
sceptipal  patient. 

'1  must  b,eg  you  to  do  exactly  as  I  tell  you,"  I 
remark  categorically.  "Only  on  this  condition  can 
I  treat  your  case."  And  my  whole  tone  implies 
that  I  am  in  possession  of  supreme  knowledge,  to 
doubt  which  would  be  a  gratuitous  insult. 

Do  not  think  that  it  is  sufficient  to  win  this  con- 
fidence once;  the  struggle  for  its  maintenance  must 
be  unceasing.  The  patient's  illness  is  prolonged; 
one  must  keep  a  sharp  eye  on  his  psychical  state  as 
well  as  on  that  of  his  relatives;  at  the  first  sign  of 
their  losing  heart,  it  is  necessary — if  only  in  out- 


DOCTOR  AND  PATIENT  187 

ward  appearances — to  change  the  treatment,  pre- 
scribe some  new  mixture,  change  the  dose;  one  has 
to  take  a  thousand  trivialities  into  account,  straining 
all  the  powers  of  one's  imagination,  finely  studying 
the  character  and  taking  stock  of  the  mental  devel- 
opment of  the  sufferer  and  those  about  him.  What 
I  had  originally  imagined  to  be  the  work  of  the 
doctor,  the  pedantic  carrying-out  of  the  cut-and- 
dried  ordinations  of  medicine,  proved  to  be  very 
remote  indeed  from  all  this.  A  Turkish  physician 
of  the  people,  a  hadja^  prescribes  for  his  patient, 
hangs  numerous  amulets  and  finally  blows  upon 
him;  everything  depends  upon  the  last  act:  only  a 
hadja  endowed  with  a  "good  breath"  can  treat  the 
sick.  The  same  "good  breath"  is  required  of  the 
bond  fide  doctor  too.  He  may  be  gifted  with  a 
magnificent  talent  of  discrimination,  be  capable  of 
discerning  the  finest  details  of  the  action  of  his  pre- 
scriptions— and  all  this  will  avail  hirti  nothing,  if 
he  lacks  the  qualities  necessary  for  the  conquest  and 
subjugation  of  the  patient's  soul.  Of  course,  there 
are  truly  educated  patients  who  do  not  stand  in  need 
of  this  "good  breath,"  who  set  a  higher  value  upon 
talent  and  knowledge  and  do  not  fear  the  naked 
truth.  But  such  patients  are  as  rare  amongst  men 
as  genius  itself. 


CHAPTER  XII 

THE    DOCTOR   AND    THE    POOR 

IT  took  me  a  long  time  for  my  mental  focus  to 
adjust  itself  to  view  the  powers  vested  in  medi- 
cine in  their  true  proportions  and  to  recognise  the 
limitations  of  the  latter.  When  in  the  presence  of 
a  patient  to  whom  I  was  powerless  to  give  relief,  I 
used  to  feel  distressed  and  ashamed;  standing  before 
me,  sullen  and  despairing,  he  was  a  living  incarna- 
tion of  heavy  reproach  to  that  science  which  I  rep- 
resented. And  again  and  again  maledictions  would 
rise  up  in  my  breast  at  the  impotence  of  this  science. 

".  .  .  Was  hab'  ich 
.  .  .  Wenn  ich  nicht  alles  habe."  ^ 

To  this  one  I  could  bring  relief,  this  one  was  be- 
yond my  aid;  nevertheless  all  of  them  flocked  to 
me,  all  burned  with  the  same  desire  to  get  well,  all, 
with  equal  right,  expected  salvation  at  my  hands. 
The  cries  of  despairing  anguish  that  fill  the  intimate 
correspondence  of  the  mightiest  representatives  of 
the  profession  are  very  human  and  intelligible. 
And  the  greater  the  man,  the  more  acutely  is  he 

1  "What  have  I,  if  I  have  not  all?" 

l88 


THE  DOCTOR  AND  THE  POOR     189 

made  to  feel  his  own  helplessness.  "Out  of  all  my 
work,  my  lectures  alone  interest  me  and  retain  their 
life,"  wrote  Botkin  ^  to  his  friend  Dr.  Belogolovy. 
"The  rest  I  drag  along  as  a  man  on  the  towing  path 
drags  his  rope,  prescribing  a  mass  of  superfluous 
medicines.  This  is  no  empty  phrase,  and  will  help 
you  to  understand  why  my  practical  work  in  my 
polyclinic  oppresses  me  so.  Having  a  tremendous 
number  of  chronic  cases  under  my  observation,  I 
have  begun  to  realise  with  sadness  how  impotent 
our  therapeutic  remedies  are.  Hardly  a  polyclinic 
passes  without  the  bitter  reflection :  'why  had  I  taken 
money  from  half  the  patients  and  put  them  to  the 
further  expense  of  buying  one  or  other  of  our  phar- 
maceutical remedies,  which,  after  affording  relief 
for  four  and  twenty  hours,  would  work  no  appre- 
ciable change  in  their  condition  *?'  Forgive  me  for 
this  hypochondria,  but  this  was  my  day  for  private 
consultations,  and  I  am  under  the  fresh  impression 
of  my  fruitless  work." 

Billroth  wrote  some  verses,  not  intended  for  pub- 
lication, which  he  sent  to  his  friend  the  celebrated 
composer  Brahms.  It  is  difficult  to  render  in  trans- 
lation the  power  and  poetry  of  this  fragment: — 

"Ich  kann's  nicht  mehr  ertragen, 
Wie  mich  die  Mensehen  taglich,  stiindlich  qualen, 
Wie  sie  Unmogliches  von  mir  begehren ! 

2  One  of  Russia's  greatest  physicians  of  the  latter  half  of  the 
nineteenth  century  (deceased). — ^Translator. 


iQo    THE  MEMOIRS  OF  A  PHYSICIAN 

Weil  ich  ein  wenig  tiefer  wohl  als  andere 
*  In  die  Natur  geheimstes  Wesen  drang, 

So  meinen  sie,  ich  konnte  gleich  den  Gottern 
Durch  Wunder  Leiden  nehmen,  Gluck  erzaubern, 
Und  bin  doch  nur  ein  Mensch  wie  andere  mehr. 
Ach,  wiisstet  Ihr,  wie's  in  mir  wallet,  siedet, 
Und  wie  mein  Herz  den  Schlag  zurucke  halt, 
t         Wenn  ich  statt  Heilung  mit  unsicheren  Worten 
Kaum  Trost  kann  spenden  den  Verloren.  •  .  • 
•  .  .  Was  soil  denn  aus  mir  werden*? 
Aus  mir,  den  viel  bewunderten,  hiilflosen  Mann  ?"  * 

* 

But  one  had  to  humble  oneself  gradually  in  the 
presence  of  this  impotence:  the  inevitable  always 
carries  a  kind  of  reconciliation;  for,  after  all  said 
and  done,  science  gave  us  considerable  powers, 
which  allowed  us  to  accomplish  much.  But  what 
I  could  not  reconcile  myself  to  and  what  shook  my 
satisfaction  in  my  life's  work,  was  the  utter  ficti- 
tiousness  of  these  powers  in  the  face  of  modern 
reality. 

Medicine  is  a  science  devoted  to  the  healing  of 

*  "I  cannot  bear  this  longer 
When   people   daily,   hourly  torment  me, 
When   they   demand   the  impossible   of   me! 
Because    I   have    penetrated    a    little    further    than   others 
Into    the   most    secret   depths   of    nature, 
They  believe  that,  god-like, 

I  can  by  miracle  relieve  their  suffering,  conjure  happiness, 
While  I  am  but  a  man,  just  as  others. 
Oh,  if  you  but  knew  how  everything  wells  up  and  seethes  within 

me, 
And  how  my  heart-pulse  falters. 
When,   instead  of  healing,  with  broken  words 
I  am  barely  able  to  dispense  comfort  to  the  lost  ones  .  .  . 
What  will  become  of  me. 
Of  me  a  helpless  man,  the  object  of  so  much  wonder?" 


THE  DOCTOR  AND  THE  POOR     191 

mankind.  So  much  was  to  be  inferred  from  our 
books  and  our  studies  at  the  University.  But  life 
proved  conclusively  that  medicine  was,  as  a  matter 
of  fact,  a  science  dealing  with  the  treatment  of  the 
Wealthy  and  leisured.  As  far  as  the  rest  were  con- 
cerned, it  was  but  a  theoretical  abstraction,  which 
told  us  how  one  might  cure  people,  if  they  were  rich 
and  free.  What  I  was  compelled  to  offer  them,  in 
the  absence  of  these  conditions,  was  no  more  nor  less 
than  the  most  brazen  profanation  of  the  healing  art. 
At  rare  intervals  on  holidays,  a  small  boy — an 
apprentice  from  a  neighbouring  cobbler's  shop, 
attends  my  consulting  hours.  His  face  has  the 
greenish-pale  hue  of  mildewed  plaster  and  he  suf- 
fers from  vertigo  and  fainting  fits.  I  often  pass  the 
workshop  where  he  toils — its  windows  open  upon 
the  street..  Whether  it  be  at  six  o'clock  in  the 
morning  or  at  eleven  at  night,  I  never  fail  to  see 
the  cropped  head  of  this  poor  child  bending  over 
a  boot,  and  around  him  other  green-complexioned, 
emaciated  apprentices  and  boys;  a  small  petroleum 
lamp  feebly  burns  above  their  heads,  and  through 
the  open  window  rolls  forth  a  thick  nauseating 
stench  that  turns  the  stomach.  I  have  to  treat 
poor  little  Ivan  the  apprentice.  I  ought  to  come 
and  tear  him  away  from  that  dark,  noisome  kennel, 
take  him  out  of  town  and  let  him  run  about  the 
fields  in  the  hot  sunshine,  inhaling  the  soft  country 
breezes:  his  lungs  would  expand,  his  heart  grow 


192     THE  MEMOIRS  OF  A  PHYSICIAN 

strong  and  his  blood  turn  warm  and  red.  Whereas, 
even  the  dusty  streets  of  the  metropolis  see  him 
only  on  those  rare  occasions  when  his  employer 
sends  him  on  an  errand  to  a  customer;  even  on  holi- 
days he  is  allowed  no  exercise,  for  his  master  locks 
him  in  the  workshop  together  with  the  other  boys, 
so  as  to  keep  them  out  of  mischief.  .  .  .  All  I  can 
do  is  to  prescribe  some  iron  and  arsenic  for  the  poor 
lad,  and  derive  what  comfort  I  may  from  the  re- 
flection that  still  I  am  "doing  something"  for  him. 

A  washerwoman  suffering  from  eczema  of  the 
hands  comes  to  me,  or  else  a  drayman  with  hernia, 
or  a  consumptive  weaver;  I  prescribe  salves,  pills 
and  powders  all  round  and,  myself  ashamed  of  the 
farce  I  am  keeping  up,  tell  them  in  deprecatory 
tones  that  the  chief  conditions  necessary  for  their 
recovery  are  as  follows:  that  the  washerwoman 
should  not  wet  her  hands,  that  the  drayman  should 
not  strain  himself  by  lifting  weights,  and  that  the 
weaver  should  keep  out  of  dusty  places.  They  sigh, 
thank  me  for  my  ointments  and  powders,  and  ex- 
plain that  they  cannot  give  up  their  occupations 
because  they  must  eat. 

At  such  moments  I  am  consumed  with  shame  for 
myself  and  the  science  I  serve,  for  the  puling  little- 
ness to  which  it  is  condemned  when  brought  into 
operation. 

In  the  country,  a  peasant  suffering  from  great 
shortness  of  breath  came  to  me  one  day.     I  found 


THE  DOCTOR  AND  THE  POOR     193 

his  left  lung  to  be  affected  by  croupous  inflamma- 
tion through  and  through.  I  v/as  amazed  that  he 
should  have  been  able  to  reach  me,  and  told  him 
that  he  must  go  to  bed  immediately  on  his  return 
home,  and  keep  there. 

"Why,  sir,  how  can  I?"  It  was  his  turn  to  show 
amazement.  "Don't  you  know  what  season  this 
is'?  These  are  busy  times,  the  harvest  has  to  be 
gathered  in.  The  Lord  has  sent  us  fine  weather 
and  you  tell  me  to  lie  in  bed!  Why,  don't  you 
know  what  that  would  mean?  No,  no  I  You  just 
be  kind  and  give  me  some  drops  to  ease  my  chest." 

"But  don't  you  understand,  no  drops  will  do  you 
any  good  if  you  go  to  work!  This  is  no  joking 
matter — you  may  die !" 

"The  Lord  is  merciful,  why  should  I  die"?  Pll 
get  over  it  somehow.  Any  way,  I  can't  possibly 
stay  a-bed;  we  live  for  the  whole  year  on  the  work 
of  these  three  weeks."  With  my  mixture  in  his 
pocket  and  his  scythe  over  his  shoulder,  he  trudged 
off  to  his  field  and  reaped  his  rye  till  evening,  then 
lay  down  under  his  hedge  and  died  of  anasarca  of 
the  lungs. 

Ruthless,  gigantic  and  resistless  in  its  passionless 
sway,  life  ceaselessly  does  its  blind,  cruel  work,  while 
somewhere,  far  below,  at  its  feet,  the  puny  science 
called  medicine  potters  about,  evolving  its  hygienic 
and  therapeutic  "Standards." 

We  have  before  us  the  human  system  with  all  its 


194     THE  MEMOIRS  OF  A  PHYSICIAN 

organic  wealth  and  diversity,  demanding  broad  and 
unfettered  scope  for  its  functions;  while  the  mission 
of  life  would  appear  to  centre  in  a  gruesome  experi- 
ment of  what  this  organism  would  come  to  if  placed 
in  the  most  impossible  conditions.  Some  people 
are  condemned  to  everlasting  walking  and  standing 
about  without  rest;  their  soles  flatten,  their  legs 
swell,  the  veins  on  their  calves  become  strained  and 
gradually  develop  into  unhealing  ulcers..-  Others 
are  compelled  to  lead  a  sedentary  life;  their  backs 
become  crooked,  liver  and  lungs  compressed,  bleed- 
ing piles  appear  in  the  rectum.  Miners  have  to  toil 
all  day  long  on  their  hands  and  knees  in  the  dark, 
close  galleries  of  coal  pits;  the  blowers  at  glass 
manufactories  only  work  with  their  lungs,  which 
they  convert  into  bellows.  There  are  no  unnatural 
movements  or  positions  in  which  people  are  not  com- 
pelled to  pass  their  days,  there  are  no  poisons  which 
they  are  not  forced  to  inhale,  there  are  no  circum- 
stances of  existence  which  life  does  not  compel  them 
to  adopt. 

I  have  just  returned  from  visiting  a  broken-down 
cigarette-maker;  she  dwells  in  the  corner  of  a  tene- 
ment room — a  squalid,  low-ceilinged  hutch,  seven 
paces  long  by  six  broad.  Sixteen  human  creatures 
make  it  their  home.  To  remain  in  this  abode  for 
ten  or  fifteen  minutes  is  torture  to  me;  the  room 
lacks  air — this  is  no  figure  of  speech — the  lamp, 


THE  DOCTOR  AND  THE  POOR     195 

which  is  properly  trimmed  and  lit,  smokes  and  gut- 
ters— there  is  insufficient  oxygen  to  allow  of  a 
bright  flame;  the  oppressive,  moist,  almost  sticky 
atmosphere  is  impregnated  with  the  foetid  odour  of 
infantile  excrements,  twist  and  petroleum. 

The  waxen,  strangely  inanimate  faces  of  the  chil- 
dren peer  at  me  out  of  the  corners  of  the  room ;  they 
are  pigeon-chested,  their  teeth  are  crooked,  their 
limbs  rickety;  while  their  large  eyes  betray  no  trace 
of  that  liveliness  and  merriment  that  is  "natural" 
to  childhood. 

In  fact,  on  becoming  a  doctor,  I  quite  lost  my 
bearings  as  to  what  was  really  right  and  proper  in 
the  human  race.  Was  it  natural  that  a  tired  person 
should  want  to  sleep *?  No!  A  hospital  nurse,  a 
teacher,  a  journalistic  drudge,  worn  out  and  broken; 
they  cannot  go  to  sleep  without  swallowing  a  dose 
of  bromide  potassium.  Ought  a  person  who  had 
long  remained  without  food  experience  a  craving 
for  it?  No,  certainly  not!  He  finds  himself  com- 
pelled to  resort  to  an  artificial  appetizer — ^just  as 
if  he  were  a  surfeited  glutton.  This  phenomenon 
struck  me  particularly  amongst  the  majority  of  fac- 
tory hands  and  artisans. 

"You  work  all  day,  the  machinery  throbs,  the 
floor  beneath  your  feet  wobbles  like  a  live  thing. 
.  .  .  Well,  you  get  so  dog-tired  that  you  haven't 
the  heart  for  your  victuals.     You  only  just  seem  to 


196     THE  MEMOIRS  OF  A  PHYSICIAN 

want  a  good  draught  of  kvass.*  But  kvass  can't 
give  you  any  strength — it  merely  fills  up  your  belly 
— that's  all.  Vodka  is  the  only  thing  that  helps 
us  out;  after  a  little  glass,  well — you  want  to 
eat." 

For  several  years  I  have  attended  the  employees 
of  a  certain  printing  firm,  and  during  all  that  time 
I  never  came  across  an  old  compositor.  There  is 
no  old  age,  there  are  no  grey  hairs  in  that  trade — 
the  lead  dust  drives  them  all  into  an  early  grave. 

Life  conducts  its  experiments  upon  man  and 
mockingly  places  at  our  disposal  the  results  obtained 
for  further  investigation.  We  study  the  subject 
and  obtain  a  very  clear  understanding  of  the  effects 
on  man  of  chronic  phosphorus,  lead  or  mercurial 
poisoning;  the  influence  of  insufficient  light,  air  and 
exercise  upon  the  growth  of  children  is  also  made 
plain  to  us;  we  learn  that  only  nine  out  of  every 
hundred  weavers  attain  the  age  of  forty,  that  only 
six  per  cent,  of  the  women  employed  in  the  textile 
industry  live  to  the  same  age.  .  .  .  Also,  we  be- 
come acquainted  v/ith  the  fact  that  in  Russia,  owing 
to  the  arduous  nature  of  their  agricultural  work,  the 
physiological  life  peculiar  to  women  is  entirely  sus- 
pended in  the  peasant  woman  during  the  summer 
months;  that  seamstresses  and  female  students  often 
degenerate    in    a    few    years    into    ansemic,    sickly 

^  Kvass  =  a   Russian   national   non-alcoholic   beverage  made   of 
malt. — Translator. 


THE  DOCTOR  AND  THE  POOR     197 

creatures.  And  we  shall  learn  much  more  as  time 
passes.  .  .  . 

What  could  our  medicine  do  under  the  circum- 
stances? What  value  could  be  placed  upon  those 
pitiful  palliatives  with  which  it  seeks  to  patch  up 
all  that  so  disfigures  our  life'?  .... 

Great  suffering  mankind  hangs  upon  the  cross, 
his  hands  and  feet  are  transfixed  by  cruel  nails,  and 
medicine  bathes  the  ensanguined  wounds  with  arnica 
and  applies  aromatic  poultices. 

It  is  powerless  to  accomplish  more.  No  science 
can  exist  that  could  teach  us  how  to  heal  sores  with 
the  iron  still  rankling  in  them;  it  cannot  go  beyond 
showing  that  humanity  must  live  otherwise,  that 
first  of  all  the  nails  must  be  drawn  from  the  lacera- 
tions. 

Villerme's  investigations,  conducted  in  the  late 
"twenties,"  showed  that  half  the  children  of  the 
Mulhausen  weavers  died  before  reaching  the  age  of 
fifteen  months.  Villerme  persuaded  the  mill-owner 
Dollfus  to  allow  his  female  mill-hands  to  remain  at 
home  for  six  weeks  after  confinement,  retaining 
their  full  wages  the  while;  this  measure  proved  suf- 
ficient in  itself  to  lower  the  infantile  mortality  by 
fifty  per  cent,  without  any  extraneous  medical  aid. 

One  thing  v/as  ever  becoming  clearer  and  more 
incontestable  in  my  eyes:  that  medicine  can  do  no 
more  than  point  out  those  conditions  which  alone 
make  possible  a  healthy  existence  and  the  cure  of 


198     THE  MEMOIRS  OF  A  PHYSICIAN 

disease.  Therefore,  a  physician — if  he  be  a  phy- 
sician and  not  a  mummified  medical  functionary — 
must  first  of  all  strive  to  remove  those  conditions 
which  at  present  render  his  work  both  senseless  and 
barren;  he  must  be  a  public  worker  in  the  broadest 
sense  of  the  term;  he  must  not  only  prescribe,  but 
he  must  strive  and  seek  to  discover  the  means  for 
carrying  his  directions  out  of  theory  into  actuality. 

And  the  need  for  undelayed  action  is  all  the  more 
imperative,  because  time  does  not  wait  and  life  is 
rapidly  carrying  humanity  towards  the  brink  of  a 
dark  abyss.  The  numbers  of  the  "unbalanced," 
physically  unfit,  and  hereditary  drunkards  are  ever 
on  the  increase,  the  halt,  blind,  deaf  and  stammer- 
ing are  ever  multiplying. 

The  best  criterion,  for  an  estimation  of  the  physi- 
cal condition  of  the  people,  is  furnished  by  the  per- 
centage of  conscripts  eligible  as  soldiers  in  those 
countries  where  military  service  is  obligatory — and 
we  see  that,  year  by  year,  this  number  is  falling  off 
everywhere,  like  a  barometrical  column  before  a 
storm.  In  Austria,  for  instance,  in  1870  the  num- 
ber of  those  who  came  up  to  the  standard  was 
twenty-six  per  cent.,  in  1875  eighteen  per  cent.,  in 
1880  fourteen  per  cent.  This  is  degeneration  with 
a  vengeance,  which  can  almost  be  grasped  by  the 
hands,  so  to  speak!  One  of  our  anthropologists 
ventures  upon  a  prophecy  as  to  the  future,  and  his 
words  have  the  ring  of  cruel  truth  about  them — 


THE  DOCTOR  AND  THE  POOR     199 

they  are  not  a  mere  empty  phantasmagoria.  "The 
ideal  of  a  harmonious  social  order,  with  its  interests 
at  one,  may  not  be  realised,  owing  to  the  degenera- 
tion of  humanity.  A  centralised  feudo-industrial 
system  will  establish  itself,  in  which  the  popular 
masses  will  be  relegated,  in  somewhat  modified 
form,  to  the  position  of  the  helots  of  ancient  Sparta, 
organically  adapted  to  such  a  state,  owing  to  their 
own  degeneration." 


CHAPTER  XIII 

MEDICINE,    NATURAL    SELECTION    AND    THE 
SURVIVAL    OF    THE    UNFIT 

BUT  I  will  suppose,  for  the  sake  of  argument, 
that  social  conditions  have  undergone  a  radical 
change.  Every  one  is  placed  in  a  position  to  fol- 
low all  the  dictates  of  hygiene;  we  doctors  are 
enabled  to  offer  each  patient  all  that  medical  science 
requires.  Would  our  work  be  so  sure  to  prove  of 
indisputable  benefit  free  from  contradictions^ 

Already  we  have  to  hear  more  and  more  often 
the  cry  raised  amongst  doctors  and  anthropologists, 
that  medicine  is  terribly  one-sided  and  that  its  use- 
fulness to  mankind  is  open  to  grave  question. 
"Medicine  benefits  the  individual  at  the  expense  of 
the  type."  Mother  Nature  is  prodigal  and  care- 
less: she  casts  numberless  creatures  upon  the  world, 
not  caring  much  as  to  the  perfection  of  each  speci- 
men; the  task  of  weeding  out  and  destroying  the 
unsuccessful  and  unfit  is  left  to  merciless  life.  And 
it  is  here  that  medicine  appears  upon  the  scene  and 
strains  all  its  energies  to  frustrate  this  work.  v. 

A  woman  in  child-bed  may  have  narrow  hips  and 
she  cannot  give  birth ;  she  and  her  child  must  perish ; 

200 


MEDICINE;  NATURAL  SELECTION     201 

medicine  steps  in  and  saves  both,  and  thus  enables 
women  with  bad,  narrow  hips,  unadapted  for  child- 
birth, to  multiply.  The  higher  the  infantile  death- 
rate,  which  medicine  so  energetically  combats,  the 
surer  is  the  next  generation  of  being  purged  of  all 
weakly  and  sickly  organisms.  The  syphilitic,  tu- 
berculous, rickety,  mentally  infirm  and  nervous  in- 
dividuals, cured  through  the  good  offices  of  medicine, 
breed  and  produce  a  puny  and  nervous  degenerated 
posterity.  All  these  weaklings  who,  although  they 
have  been  preserved,  are  rotten  to  the  core,  mix  and 
cross  with  the  healthy  and  thus  conduce  to  the  rapid 
degeneration  of  the  race  in  general.  And  every 
new  success  of  medicine  will  accelerate  this  down- 
ward progress  of  deterioration. 

Before  his  death  Darwin  had  solid  grounds  for 
imparting  to  Wallace  his  despondent  views  on  the 
future  of  humanity,  owing  to  natural  selection  and 
survival  of  the  fittest  having  no  room  in  modern 
civilisation. 

This  spectre  of  universal  degeneration  is  so  real 
and  glaring  that  it  gives  us  food  for  serious  and 
deep  reflection.  Many  have  made  this  knotty  prob- 
lem the  subject  of  profound  thought,  and  the  most 
far-reaching  reformatory  projects  are  mooted  for 
averting  the  danger.  Proposals  have  been  put  for- 
ward that  "all  philanthropy"  should  be  eradicated 
from  human  society  and  hum.anity  transformed  into 
a  kind  of  vast  stud- farm  under  the  supreme  direc- 


202    THE  MEMOIRS  OF  A  PHYSICIAN 

tion  of  anthropo-technical  physicians.  It  is  not 
difficult  to  invent  schemes  of  a  like  nature  at  one's 
study  table:  "The  Happiness  of  Humanity'*  as- 
sumes such  majestic  and  real  proportions,  while 
living  individuals,  transformed  into  dumb  ciphers, 
are  so  easily  amenable  to  addition  and  subtraction! 
.  .  .  But  after  all,  perhaps  the  essence  of  life  is 
concentrated  in  the  individual  consciousness  of  the 
unit,  and  outside  this  sphere  the  rest  fades  into  in- 
significance. To  the  lasting  honour  of  humanity 
be  it  said,  that  the  praiseworthy  instinct  to  break 
down  the  walls  of  already  existing  stables  shows 
itself  to  be  ever  in  the  ascendent,  and  men  give  no 
indications  of  wanting  to  build  up  fresh  prison 
walls.  .  .  .  Nevertheless  the  fact  remains:  natural 
selection  is  on  the  wane,  while  medicine  is  always  as- 
sisting this  process,  giving  absolutely  nothing  in 
exchange. 

The  consequences  of  the  disappearance  of  selec- 
tion, as  just  roughly  indicated,  do  not  stop  here,  but 
are  much  deeper  and  more  far-reaching. 

By  long  and  untiring  effort,  the  type  of  modern 
man,  more  or  less  adapted  to  his  environments,  was 
evolved.  But  these  environments  do  not  remain 
inert — on  the  contrary,  they  undergo  constant 
fundamental  changes,  which  are  compassed  with 
ever  increasing  rapidity.  On  the  other  hand,  the 
human  organism  has  ceased  to  keep  pace  with  them, 
in  the  sense  of  developing  new  and  positive  quali- 


MEDICINE;  NATURAL  SELECTION     203 

ties.  In  former  times  teeth  were  necessary  for  the 
reducing  of  hard  and  tough  food  of  moderate  tem- 
perature. Nowadays  man  consumes  soft  foods, 
either  very  hot  or  very  cold.  This  kind  of  nutri- 
ment requires  an  entirely  new  dental  apparatus — 
the  old  serves  its  purpose  no  more.  The  appalling 
number  of  bad  teeth  that  we  see  in  civilised  com- 
munities speaks  for  this.  Wild  tribes  which  are 
devoid  of  all  culture  possess  powerfully  developed 
jaws  and  strong  and  healthy  teeth.  The  semi-civi- 
lised peoples  show  a  percentage  of  between  five  and 
twenty-five  with  decayed  teeth,  whereas  80  per  cent, 
of  the  population  of  highly  cultured  communities 
are  affected  by  dental  corrosion.^ 

Pray  give  this  your  full  attention:  the  living  or- 
ganism in  a  state  of  rot  and  corruption  in  the  living 
man!  There  is  nothing  exceptional  about  this — 
on  the  contrary,  such  is  the  rule  with  but  insignifi- 
cant deviations.  Either  man  must  return  to  his 
former  food,  or  else,  evolve  new  teeth  I  How  does 
medicine  act  in  the  meanwhile?  It  cleans,  fills  and 
treats  these  teeth  and  does  all  it  can  to  fortify  those 

1  Researches  instituted  to  ascertain  the  condition  of  the  teeth  of 
the  female  pupils  being  educated  in  the  schools  of  the  Russian  Impe- 
rial Humane  Society,  showed  how  gigantic  were  the  strides  made  by 
dental  decay,  with  the  advance  of  age.  The  pupils  were  divided 
into  three  groups  according  to  age:  (i)  from  8-12,  (2)  from  12-16, 
(3)  from  16-20.  The  first  group  showed  that  79  per  cent,  had 
spoilt  teeth,  each  girl  averaging  three  bad  ones;  the  second  dis- 
closed 87  per  cent.,  with  an  average  of  4.5  bad  ones  for  each;  in 
the  third  group  there  were  $2  per  cent.,  an  average  of  5.9  bad 
teeth  being  constated. 


204    THE  MEMOIRS  OF  A  PHYSICIAN 

remaining  intact,  which  will,  in  their  turn,  go,  be- 
cause they  cannot  help  it. 

Formerly  man  required  his  eyes  chiefly  for  long 
distance  vision,  and  they  entirely  answered  their 
purpose.  Conditions  of  life  have  undergone  a 
change,  the  organ  has  to  meet  the  requirement  for 
more  work  at  close  quarters ;  a  new  organ  must  evolve 
itself,  equally  efficient  for  long  vision  and  short 
focus  work.  But  medicine  accommodatingly  sup- 
plies the  short-sighted  eye  with  a  lens — thus  the 
unserviceable  organ  is  made  serviceable  by  purely 
extraneous  devices.  The  number  of  the  myopic  is 
constantly  on  the  increase,  and  all  that  remains  to  us 
is  to  thank  the  Lord  that  there  will  ever  be  sufficient 
glass  to  provide  all  with  spectacles. 

The  fact  that  the  human  organism  does  not  ac- 
quire those  positive  qualities  which  are  essential  to 
the  changed  conditions  of  life,  is  thus  made  plain. 
But  worse  is  to  follow :  the  human  organism  shows  a 
serious  tendency  to  lose  those  it  already  possesses. 
Medicine,  in  the  pursuit  of  its  aims,  threatens  to  do 
humanity  a  very  poor  service  in  this  direction  too. 

What  is  modern  medicine's  ideal?  It  lies  in  the 
stamping  out  of  every  disease  in  its  inception,  or 
better  still — in  not  admitting  it  into  the  system  at 
all.  For  instance,  surgery  insistently  demands  that 
the  most  insignificant  scratch  or  cut  should  immedi- 
ately be  subjected  to  careful  antiseptic  treatment. 
In  each  separate  case  this  may  answer  very  well, 


MEDICINE;  NATURAL  SELECTION     205 

but  if  applied  habitually  and  universally,  the  system 
will  entirely  lose  its  powers  of  independent  struggle 
with  infection  I  At  the  present  day  a  vast  accumu- 
lation of  observation  has  established  the  fact  that 
savages  easily  recover,  without  any  special  treat- 
ment, from  wounds  that  would  kill  the  European, 
notwithstanding  the  most  careful  nursing. 

Then,  again,  let  us  take  infectious  diseases  in  gen- 
eral. The  human  system  shows  far  greater  powers 
of  resistance  in  regard  to  complaints  that  are  pecul- 
iar to  a  given  district  and  a  given  nationality,  than 
towards  diseases  hitherto  unknown.  Amongst  sav- 
ages scarlet  fever  and  measles  carry  away  half  the 
population  at  a  sweep.  Num^erous  as  is  the  number 
of  Polynesian  aborigines  exterminated  by  arms,  the 
"white  sickness"  (phthisis)  has  claimed  far  more 
numerous  victims. 

"Who  killed  your  father^  Who  killed  your 
mother'?" 

"The  white  sickness  I" 

A  Polynesian  woman,  entering  into  relations  with 
a  white,  invariably  falls  victim  to  consumption ;  this 
is  not  all — she  infects  her  native  lovers  as  well.  If 
an  Australian  aboriginal  passes  a  few  days  in  a 
European  town  of  New  Holland,  he  contracts  con- 
sumption (according  to  Krjivitsky). 

On  the  other  hand,  the  European  as  easily  suc- 
cumbs to  tropical  malaria,  yellow  fever  and  tropi- 
cal dysentery.     What  would  the  result  be  if  all 


2o6    THE  MEMOIRS  OF  A  PHYSICIAN 

infectious  diseases  were  destroyed  by  science  in  the 
germ?  Entirely  strange  to  them,  man  would  fall 
their  victim  swiftly  and  surely,  if  chance  deprived 
him  of  his  accustomed  protection.  Finally  he  would 
lose  every  vestige  of  independence,  not  daring  to 
stray  a  yard  from  the  protecting  wing  of  medicine. 
I  recently  came  across  an  article  containing  the  fol- 
lowing reflections  on  the  aims  of  medicine:  "It 
will  only  then  be  possible  to  safeguard  the  system 
from  that  varied  multitude  of  poisons  that  are  con- 
stantly being  introduced  by  different  microbes,  when 
one  universal  antitoxin  for  all  these  shall  have  been 
discovered.  This  desideratum  once  attained,  we 
should  merely  have  to  inject  daily  into  our  blood  a 
fixed  amount  of  the  antitoxic  fluid  and  thus  antici- 
pate the  malignant  effects  of  the  poisons  which  the 
micro-organic  world  daily  introduces  into  our  bodies. 
At  present,  unfortunately,  there  are  not  the  slightest 
grounds  for  believing  in  the  realisation  of  such  rosy 
hopes." 

Is  not  this  awful !  To  be  forced  to  inject  a  dose 
of  universal  antitoxin  beneath  your  skin  every  day 
of  your  life,  when  rising!  And  if  you  forget  to — 
you  perish  because  the  first  stray  bacillus  will  be 
sufficient  to  give  your  poor  organism,  which  has  lost 
all  capacity  of  self -protection,  its  coup  de  grace. 

The  science  called  hygiene  tells  us  that  we  should 
not  sleep  between  window  and  stove:  the  draught 
caused  by  the  difference  of  temperature  of  the  cold 


MEDICINE;  NATURAL  SELECTION    207 

window  panes  and  the  warm  stove  might  give  us  a 
cold.  Hygiene  warns  us  against  hard  out-door 
work  on  cold  winter  days,  as  our  deep  inspirations 
conduce  to  the  violent  cooling  of  the  lungs,  which 
might  result  in  a  chill.  But,  pray,  why  does  not  a 
crow  become  enrheumed  through  sleeping  in  the  bit- 
ing autumn  wind;  why  do  not  the  reindeer,  that 
madly  gallop  over  the  frozen  tundra  at  a  freezing 
temperature  of  forty  degrees  below  zero,  contract 
pneumonia?  The  crows  and  the  reindeer  that 
caught  cold  died  off,  thus  purifying  the  species  of 
unadapted  units,  while  we  have  no  right  to  leave 
the  weak  human  creature  to  the  mercy  of  the  laws 
of  survival  of  the  fittest.  No  one  will  say  a  word 
against  this.  But  medicine  should  strive  and  make 
those  weak  creatures  strong.  Unfortunately,  it  re- 
verses the  process,  makes  the  strong  weak  and  seeks 
to  turn  all  men  into  pitiful,  helpless  beings,  tied  to 
its  apron-strings. 

However,  it  is  a  matter  for  deep  congratulation 
that,  of  late,  science  shows  indications  of  choosing 
other  paths,  which  bid  fair  to  lead  us  in  the  future 
to  much  that  is  consolatory.  In  this  respect  the 
experiments  in  artificial  immunisation  of  man  are 
especially  noteworthy.  Although,  as  yet,  not  con- 
clusively proven,  it  is  very  probable  that  the  essence 
of  the  action  of  such  immunisation  lies  in  the  train- 
ing of  the  organic  forces  in  the  independent  struggle 
with  those  microbes  and  poisons  which  force  their 


2o8    THE  MEMOIRS  OF  A  PHYSICIAN 

way  into  the  system.  If  this  really  be  so,  we  have 
to  deal  with  a  vast  revolution  of  the  very  founda- 
tions of  medicine:  instead  of  hastening  to  rid  him 
of  the  disease  that  has  already  taken  root,  medicine 
will  convert  man  into  a  combatant  himself,  able  to 
deal  with  the  dangers  menacing  him.  Here  we 
have  before  us  an  illustration  of  one  of  those  meth- 
ods whereby  medicine,  without  claiming  any  vic- 
tims, may  arrive  at  leading  civilised  humanity  to 
the  same  desideratum  which  savage  communities 
attain  through  survival  of  the  fittest,  at  the  price  of 
great  waste  of  life. 

The  dreams  of  to-day  will  be  the  reality  of  to- 
morrow; science  preserves  within  itself  much  latent 
and,  to  itself,  unknown  energy;  and  we  have  the 
right  to  expect  that  the  science  of  the  future  will 
find  more  ways  than  one  for  the  achievement  of  the 
same  object  as  that  pursued  by  nature — but  in  a 
manner  reconciling  the  interests  of  the  individual 
and  the  type. 

To  what  extent  and  within  what  limits  this  will 
prove  feasible,  remains  to  be  seen — we  cannot  con- 
jecture beforehand.  But  this,  the  true  anthropo- 
technic  will  have  many  problems  to  solve — prob- 
lems both  wide-reaching  and  knotty — perhaps  insol- 
uble, but  none  the  less  burning. 

"All  that  leaves  the  hands  of  Nature  is  perfect." 
Rousseau's  celebrated  dictum  has  long  been  ex- 
ploded, in  respect  to  man  no  less  than  to  nature's 


MEDICINE;  NATURAL  SELECTION     209 

other  creations.  The  present  day  has  overtaken  the 
human  animal  in  an  evolutionary  stage:  still  re- 
taining numberless  defects,  in  some  respects  he  is 
insufficiently  developed,  while  many  organs  repre- 
sent atrophied  relics  of  a  bygone  age.  Every  whit 
as  if  man  had  been  suddenly  snatched,  unfinished 
and  incomplete,  from  Nature's  laboratory,  while  the 
process  of  his  shaping  was  in  full  swing. 

For  example,  at  the  commencement  of  the  colon 
is  located  the  short  cczcum^  or  blind  intestine,  whereas 
in  our  zoological  ancestors  it  existed  in  the  form  of 
a  large  and  necessary  organ,  still  surviving  as  such 
in  the  herbivorous  animals  of  to-day.  Ceasing  to 
serve  any  useful  purpose  in  man,  this  organ  did  not, 
however,  disappear,  but  transformed  itself  into  a 
long,  narrow,  worm-like  outgrowth  appending  to 
the  c cecum.  Not  only  does  this  obsolete  survival 
serve  no  useful  purpose,  but  its  presence  is  a  source 
of  positive  danger  to  man;  the  pips,  seeds  and  such 
like  contained  in  the  chyme,  frequently  find  their 
way  into  this  cul-de-sac  and  cause  serious,  and  often, 
fatal  inflammation  of  the  vermiform  process  {ap- 
pendicitis^. 

Pursuing  our  investigations  further,  we  see  that 
the  disposition  of  man's  vitals  has  not  as  yet  finally 
adapted  itself  to  his  upright  carriage.  We  should 
clearly  realise  how  violently  this  change  of  carriage 
must  needs  have  affected  the  distribution  and  extent 
of  the  stresses  exercised  upon  our  various  organs. 


:2io     THE  MEMOIRS  OF  A  PHYSICIAN 

and  we  shall  easily  understand  that  their  ta^  of 
accommodating  themselves  to  the  changed  condi- 
tions was  far  from  light.  Without  enumerating 
all  the  defects  resulting  from  this,  I  need  only  draw 
attention  to  one  of  the  most  important:  nearly  half 
of  all  the  female  complaints  known  are  caused  by 
various  displacements  of  the  womb.  At  the  same 
time  a  large  proportion  of  these  displacements 
would  never  occur,  and  the  rest  would  be  cured  with 
much  greater  ease,  if  women  walked  on  all  fours. 
Even  as  a  temporary  measure  the  so-called  genu- 
pectoral  position  {a  la  vache)^  introduced  by 
Marion  Sims,  is  invaluable  in  gynaecology  and 
obstetrics:  some  gynaecologists  hail  Marion  Sim's 
discovery  as  "the  turning-point  in  the  history  of 
gynaecology." 

Making  women  the  subject  of  our  special  atten- 
tion, we  stumble  upon  such  a  mass  of  the  most 
grave  physiological  contradictions  and  defects  in 
her  organisation,  that  the  mind  absolutely  declines 
to  acquiesce  in  their  being  proper  and  "normal." 

The  definition  of  woman  as  "an  animal  naturally 
weak  and  sickly,  only  enjoying  occasional  bright 
periods  of  health  which  show  up  against  a  back- 
ground of  uninterrupted  disease,"  is  no  less  sad  than 
true.  The  healthiest  of  women — the  most  pains- 
taking research  furnishes  conclusive  proof  to  this 
effect — is  periodically  unmistakably  ill.  And  it  is 
impossible  to  explain  such  an  anomaly  otherwise 


MEDICINE;  NATURAL  SELECTION     211 

than  by  assuming  it  to  be  the  result  of  a  transmi- 
gratory  stage  towards  another,  more  perfect  state. 
Maternity  furnishes  a  repetition  of  the  same  story: 
the  female  in  woman  is  ever  becoming  less  pro- 
nounced— there  being  nothing  "unnatural"  in  this, 
because  she  too  possesses  a  brain  with  all  its  broad 
and  mighty  calls.  At  the  same  time  she  cannot, 
without  radically  changing  her  nature,  renounce 
love  with  its  accompaniment  of  uninterrupted  ma- 
ternity, which  saps  the  strength  of  woman  in  its 
bloom.  Two  demands,  equally  potent  and  legiti- 
mate, come  into  collision;  but  as  long  as  the  organ- 
ism remains  as  it  is,  there  is  no  help  for  it. 

Metschnikoff  points  out  another  crying  contradic- 
tion— one  dealing  with  the  sexual  instinct.  A  child 
is  altogether  unfit  for  propagation,  yet  the  sexual 
instinct  is  so  far  individualised  that  the  child  is 
enabled  to  abuse  it.  The  growth  of  the  hip-bones 
in  a  young  girl,  on  completion  of  which  she  becomes 
ripe  for  maternity,  is  only  achieved  at  the  age  of 
twenty,^  while  pubescence  comes  at  sixteen.  In 
consequence  of  this,  the  three  moments  which  ought 
to  coincide — that  of  the  awakening  of  the  sexual 
instinct,  its  satisfaction  and  the  function  of  repro- 
duction, are  separated  from  each  other  by  periods 
of  several  years.     A  girl  may  experience  the  desire 

2  Statistical  data  fully  bear  out  Metschnikoff 's  contentions :  ac- 
cording to  Bertillon,  the  death-rate  amongst  spinsters  of  the  ages 
from  15-20  amounts  to  7  per  cent.,  whereas  that  of  married  women 
of  the  same  age  is  as  high  as  50  per  cent. 


212     THE  MEMOIRS  OF  A  PHYSICIAN 

to  be  a  wife  at  ten,  she  can  only  become  one  at  six- 
teen, while  she  may  only  be  a  mother  at  twenty! 

"It  is  worthy  of  note,"  remarks  Metschnikoff, 
"that  such  perversions  of  the  natural  instincts  as 
suicide,  infanticide,  etc.,  i.e,^  just  those  so-called 
'unnatural'  actions,  are  numbered  among  the  most 
characteristic  peculiarities  of  man.  May  not  this 
point  to  the  fact  that  these  actions  are  part  and 
parcel  of  our  nature  and,  therefore,  worthy  of  the 
most  serious  attention^  It  may  be  affirmed  that  the 
genus  Homo  Sapiens  belongs  to  the  number  of  those 
which  have  not  as  yet  fully  arrived  at  stability  and 
are  not  fully  adapted  to  the  conditions  of  existence." 

The  unfitness  of  man  for  the  conditions  of  his 
existence  is  glaringly  exemplified  by  the  dispro- 
portionate weakness  of  his  nervous  system.  In  this 
respect  he  lags  badly  behind  his  times.  Actuality 
places  a  heightened  demand  on  his  nervous  powers, 
requires  an  increased  mental  expenditure ;  our  nerves 
are  unequal  to  such  intensive  work — and  resort  to 
stimulants,  artificially  quickening  the  nervous  en- 
ergy, results.  Moralists  may  essay  to  shame  us  for 
recoursing  to  such  remedies,  medicine  may  point  out 
the  "unnaturalness"  of  introducing  nicotine,  thein, 
alcohol  and  like  poisons  into  our  systems. 

But  "unnaturalness"  is  a  very  elastic  idea.  By 
themselves  many  stimulants,  such  as  tobacco,  spirits, 
beer,  etc.,  are  horrid  to  the  taste  and  their  action 
upon  the  unaccustomed  person  is  extremely  unpleas- 


MEDICINE;  NATURAL  SELECTION     213 

ant.  Why,  then,  should  every  one  of  these  excit- 
ants spread  from  its  birth-place  all  over  the  world 
so  victoriously  and  with  such  lightning  rapidity,  and 
the  "uncorrupted"  nature  of  man  fall  its  victim  so 
readily^  It  is  the  human  organism,  which  has  been 
left  behind  in  the  world's  onward  progress,  that  is 
abnormal;  it  is  unnatural  that  man  should  be 
compelled  to  draw  upon  his  surroundings  for  that 
strength  which  ought  to  be  self-contained ! 

One  way  or  another,  sooner  or  later,  the  human 
organism  must  arrive  at  a  state  of  stability  and  har- 
mony between  its  cravings  and  its  functions.  The 
attainment  of  this  end  cannot  fail  to  become  the  su- 
preme goal  of  science,  because  therein  lies  the  funda- 
mental condition  of  human  happiness.  For  these 
eternal  throes,  this  everlasting  self-distortion  must 
finally  cease  and  mankind  awaken  to  a  broad  and 
untrammelled  life,  free  to  satisfy  all  its  needs,  when 
the  very  thought  of  such  phenomena  as  "unnatural 
cravings"  will  appear  grotesquely  impossible. 


CHAPTER  XIV 

MENTAL   PROGRESS   AND    PHYSICAL   DEGENERATION 


I 


T  was  shown  in  the  foregoing  chapter  that  it  still 
remains  for  the  human  organism  to  emerge  from 
its  evolutionary  stage  and  arrive  at  final  complete- 
ness in  harmony  with  existing  conditions.  But  how 
are  we  to  foresee  the  form  this  adaptation  will  take  I 
The  hawk  soaring  at  a  dizzy  height  distinguishes 
the  lark  cowering  to  the  ground  and  is  adapted  to 
the  circumstances  of  its  existence;  so  is  the  blind 
mole  burrowing  in  the  earth.  What  is  man  destined 
to — the  freedom  of  the  hawk  or  the  slavery  of  the 
mole*?  Is  he  fated  to  improve  and  perfect  his  ex- 
isting faculties  or  to  lose  them^ 

Thanks  to  his  intellectual  superiority,  man  eman- 
cipates himself  ever  more  and  more  from  the  yoke 
of  external  nature,  is  ever  adding  to  his  independ- 
ence and  gathering  more  strength  in  his  struggle 
with  nature's  forces.  He  protects  and  shelters  him- 
self from  the  cold  by  means  of  clothing  and  habita- 
tions, he  converts  the  coarse  foods  provided  by 
nature  into  easily  assimilated  nutriment,  he  substi- 
tutes the  greater  muscular  power  of  animals  for 
his  own,  makes  mighty  steam  and  electricity  his 
servants. 

Culture  has  swiftly  wrought  many  improvements 

214 


PROGRESS  AND  DEGENERATION     215 

in  our  life  and  made  possible  such  conditions  of 
existence,  which  would  be  utterly  precluded  under 
the  sway  of  elemental  nature.  In  its  onward  prog- 
ress it  also  promises  to  place  the  comforts  that  are 
now  the  privilege  of  the  fortunate  few,  within  the 
reach  of  the  masses,  at  no  distant  date. 

The  end  to  the  domination  of  nature  over  man  is 
in  sight.  .  .  .  But  have  we  really  such  good  reason 
for  jubilation?  The  soft  waves  of  culture  have 
enfolded  us  in  their  embrace  and  carry  us  forward, 
without  allowing  us  to  see  whither  we  are  speeding; 
we  surrender  ourselves  to  these  waves  and  do  not 
perceive  how  all  the  treasures  we  possess  are,  one 
by  one,  engulfed.  Not  only  does  this  fact  escape 
our  notice — we  wilfully  ignore  it :  for  all  our  atten- 
tion is  exclusively  centred  upon  our  most  prized 
jewel — our  intellect,  which  lures  us  on  to  the  bright 
realm  of  perfect  civilisation."  But  when  we 
reckon  up  all  that  we  have  lost  already,  and  make 
a  mental  calculation  of  what  we  are  about  to  part 
with  so  blithely,  cold  fear  grips  the  heart — and  the 
dark  menace  of  some  new  form  of  human  slavery 
looms  up  ominously,  over-clouding  the  bright,  far- 
off  vistas  of  our  imaginations.  Professor  Gruber's 
measurements  show  that  the  length  of  the  alimen- 
tary canal  of  the  European  increases  appreciably 
from  S.W.  to  N.E.  Its  greatest  length  is  encoun- 
tered in  Northern  Germany,  and  especially  in  Rus- 
sia.    This  is  accounted  for  by  the  fact  that  the 


2i6     THE  MEMOIRS  OF  A  PHYSICIAN 

inhabitants  of  Northeastern  Europe  subsist  on  less 
digestible  food  than  those  of  the  Southwest.  Such 
observations  encourage  the  physiologist  in  entertain- 
ing "bright  hopes"  for  the  gradual  corporeal  regen- 
eration and  "perfecting"  of  man,  thanks  to  a  rational 
diet.  By  absorbing  for  many  generations  concen- 
trated chemical  compounds,  which  would  become 
transformed  into  blood  in  their  entirety,  without 
requiring  any  previous  preparation  by  the  digestive 
juices,  the  human  system  would  free  itself,  to  a  great 
extent,  from  the  burden  represented  by  the  digestive 
organs,  while  the  saving  in  constructive  tissue  and 
of  the  material  formerly  expended  upon  the  up- 
keeping  of  their  living  energy,  would  go  to  reinforce 
the  nobler  higher  organs  (Setschenoff  ^). 

For  the  sake  of  the  "nobler  higher  organs,"  the 
reduction  of  the  vegetative  apparatus  of  the  human 
body  to  zero  is  hailed  as  the  ideal  desideratum  of 
the  organism  of  the  future.  Herbert  Spencer  goes 
further  and  expresses  satisfaction  at  civilised  man's 
loss  of  those  qualities  which  are  typical  of  the 
savage,  viz.,  fineness  of  the  physical  senses,  keen 
perception,  skill  in  arms,  etc. 

In  his  "Principles  of  Sociology"  (vol.  i,  p.  89) 
he  remarks:  ".  .  .  in  virtue  of  a  general  antago- 
nism between  the  activities  of  the  simpler  faculties 
and  the  activities  of  the  more  complex  faculties, 

^  Professor  of  Physiology  at  the  Imperial  University  of  Moscow, 
and  a  savant  of  wide  reputation. — Translator, 


PROGRESS  AND  DEGENERATION    217 

it  results  that  this  dominance  of  the  lower  intellec- 
tual life  hinders  the  higher  intellectual  life.  In 
proportion  as  the  mental  energies  go  out  in  restless 
and  multitudinous  perception,  they  cannot  go  out  in 
calm  and  deliberate  thought." 

Civilisation  energetically  and  successfully  goes 
out  to  meet  such  ideals  half-way.  Our  olfactory 
organ  has  become  quite  rudimentary;  the  sensibility 
of  the  cutaneous  nerves  to  variations  of  temperature 
and  their  faculty  of  regulating  the  calorification  of 
the  body  has  become  appreciably  lessened;  the 
glandular  tissue  of  the  female  breast  is  becoming 
atrophied;  considerable  weakening  of  sexual  energy 
is  noticeable;  the  bones  are  becoming  smaller,  the 
first  and  the  floating  ribs  show  a  tendency  to  dis- 
appear; the  wisdom  teeth  have  become  rudimentary 
organs  and  are  entirely  lacked  by  forty- two  per  cent, 
of  Europeans ;  it  is  prophesied  that  the  double  molars 
will  follow  suit;  the  intestinal  duct  is  ever  growing 
briefer  and  the  army  of  the  bald  ever  increasing. 

When  reading  about  savages  and  their  powers  of 
endurance,  the  subtlety  of  their  external  senses,  I 
am  seized  with  bitter  envy;  I  find  it  impossible  to 
reconcile  myself  to  the  thought  that  it  is  necessary 
and  inevitable  that  we  should  lose  all  these!  The 
Guiana  native  will  tell  you  the  number  of  men, 
women  and  children  who  have  passed  along  a  forest 
path,  while  the  utmost  that  the  white  can  do  is 
to  faintly  distinguish   a  few  confused  footprints. 


2i8    THE  MEMOIRS  OF  A  PHYSICIAN 

When  Kommerson,  the  naturalist,  arrived  amongst 
the  Society  Islanders,  accompanied  by  his  servant, 
the  natives  sniffed,  smelt  the  latter  over  and  de- 
clared that  he  was  a  woman,  not  a  man  at  all :  and 
so  it  was,  for  Jeanne  Bare,  his  sweetheart,  accom- 
panied him  in  his  circumnavigation  disguised  as  his 
valet.  The  Bushman  can  starve  for  several  days 
running,  while,  on  the  other  hand,  he  can  procure 
food  where  the  European  would  die  of  hunger. 
The  Bedouin  in  the  desert  sustains  himself  for  a  day 
with  a  couple  of  gulps  of  water  and  two  handfuls 
of  parched  meal  slightly  moistened.  While  others 
shiver  from  cold,  the  Arab  sleeps  barefoot  beneath 
an  open  tent,  reposing  no  less  peacefully  upon  the 
burning  sand  in  the  full  blaze  of  the  mid-day  sun. 
While  visiting  Tierra  del  Fuego,  Darwin  saw  a 
woman  with  a  suckling  babe  approach  the  ship  out 
of  sheer  curiosity,  while  the  falling  snow  melted 
upon  the  naked  bodies  of  both  child  and  mother.  It 
was  also  whilst  among  the  Tierra-del-Fuegans  that 
the  great  naturalist  and  his  companions  felt  chilled 
while  sitting,  well  wrapped  up,  next  a  bright  camp- 
fire,  whereas  the  naked  aboriginals  sweated  pro- 
fusely, although  remaining  a  good  distance  from  the 
blaze. 

The  Yakouts  ^  are  called  the  "Iron  People"  be- 
cause of  their  insensibility  to  cold,  the  naked  chil- 
dren of  Esquimaux  and  Tschouktshi  ^   run  out  of 

2  A  Siberian  aboriginal  tribe.    ^  /^;^, — Translator. 


PROGRESS  AND  DEGENERATION     219 

their  warm  dwellings  into  the  cold,  with  the  ther- 
mometer often  as  low  as  40°  Fahr.  .  .  . 

These  people  are  as  strange  to  us  civilised  folks 
as  the  inhabitants  of  another  planet,  and  in  our  very 
conceptions  of  health  we  have  nothing  in  common 
with  them.  Our  hyper-civilised  man  walks  over  a 
dewy  lawn  barefoot  and  contracts  a  cold,  a  night 
passed  beneath  the  open  sky  cripples  him  for  life, 
a  twenty-miles'  walk  results  in  synovitis. 

And  we  consider  ourselves  healthy  notwithstand- 
ing! Thanks  to  gloves,  our  hands  will  soon  be- 
come as  sensitive  to  cold  as  are  our  feet,  and 
the  expression  "to  get  wet  hands"  will  acquire  the 
same  meaning  as  "getting  wet  feet"  at  the  present 
day. 

And  the  Lord  alone  knows  what  the  coming  age 
has  in  store,  what  gifts  and  conveniences  are  being 
prepared  for  us  in  civilisation's  laboratory!  In  the 
same  way  as  ordinary  plain  food  is  no  more  con- 
sidered a  suitable  diet  for  us,  so,  in  the  future,  will 
natural  air  become  "irrational,"  being  too  rare  and 
impure  for  our  small  and  delicate  lungs.  Man  will 
carry  an  apparatus  filled  with  concentrated,  pure 
oxygen  about  with  him,  inhaling  it  through  a  little 
tube;  and  if  his  apparatus  suddenly  goes  wrong, 
will  perish  from  suffocation  in  the  free  air  of  heaven, 
exactly  like  a  stranded  fish.  Thanks  to  improve- 
ments in  the  optical  line,  the  human  eye  will  be  able 
to  discern  a  gnat  at  ten  miles'  range,  to  see  through 


220    THE  MEMOIRS  OF  A  PHYSICIAN 

solid  earth  and  stone  walls,  itself — a  counterpart  to 
our  modern  olfactory  apparatus — transformed  into 
a  rudimentary  and  inflamed  organ,  in  daily  need  of 
syringing,  rinsing  and  cleaning.  At  present  we  live 
in  a  state  of  chronic  intoxication ;  wine,  tobacco,  tea, 
etc.,  losing  their  stimulating  properties,  humanity 
will  pass  on  to  new  and  more  potent  poisons. 
Fecundation  will  be  accomplished  artificially  as 
being  too  gross  for  man,  the  amorous  instinct  finding 
satisfaction  in  voluptuous  embraces  and  other  irri- 
tants, without  the  accompaniment  of  "filth,"  as 
described  by  Huysmans  in  his  book  "La-bas." 
Perhaps  even  things  will  go  still  further.  Profes- 
sor Eilenburg  cites  one  of  the  latest  German  writers, 
Hermann  Bahr,  who  dreams  of  an  "extra-sexual 
sensuality  and  the  substitution  of  more  refined  nerves 
for  the  low  erotic  organs."  According  to  his  opin- 
ion, the  twentieth  century  is  destined  to  make  the 
"Great  discovery  of  a  third  sex  mid-way  between 
man  and  woman,  standing  in  no  need  of  either  male 
or  female  apparatus,  because  this  new  sex  will  unite 
in  its  brain,  all  the  faculties  of  the  opposite  sexes, 
and  after  long  probation,  will  have  learned  to  suh^ 
stitute  the  imaginary  for  the  realT^ 

Pray  admire  this  "ideal  being"  freed  from  all  the 
vegetative  and  animal  functions  of  the  organism! 
In  his  celebrated  story  "The  War  of  the  Worlds," 
Wells  painted  the  Martian's  portrait  with  insuffi- 
cient vigour.     In  reality  the  creature  must  have 


PROGRESS  AND  DEGENERATION     221 

been  far  more  mighty,  helpless  and  repulsive  than 
the  being  described  by  the  novelist. 

Science  cannot  remain  blind  to  the  retrogression 
of  the  glorious  human  image  before  culture — an 
image  created  by  a  long  and  difficult  process  of  evo- 
lution. But  it  takes  refuge  in  the  reflection  that 
man  could  not  otherwise  have  developed  his  mind  in 
the  required  degree.  As  already  mentioned,  Spen- 
cer actually  evinces  satisfaction  that  this  intellect 
should  have  become  purblind  and  half  deaf,  thus 
placed  beyond  the  disturbing  influences  of  "restless 
and  multitudinous  perception."  Wiedersheim,  the 
eminent  authority  on  comparative  anatomy,  declares 
that,  by  developing  his  brain,  man  completely  made 
good  the  loss  of  a  long  array  of  useful  organic  ap- 
pliances. These  had  to  be  sacrificed  to  forward  the 
cause  of  cerebral  development,  which  has  made  man 
what  he  now  is — Homo  Sapiens. 

But  this  remains  to  be  proved!  Evidence  must 
be  forthcoming  to  show  that  the  brain  really  stands 
in  need  of  such  sacrifices  and,  what  is  still  more 
important,  that  they  cannot  be  obviated  in  future. 
If  cerebral  development  was  hitherto  purchased  at 
the  body's  expense,  it  by  no  means  follows  that  all 
other  ways  to  further  advancement  are  closed.  We 
view  our  past  losses  with  equanimity:  it  matters 
little,  after  all,  that  we  cannot  eat  other  than  easily 
digestible,  pappy  food,  that  we  must  envelop  our 
delicate,  shivering  bodies  in  warm  wraps,  stand  in 


222    THE  MEMOIRS  OF  A  PHYSICIAN 

dread  of  chills,  use  spectacles,  clean  our  teeth  and 
rinse  our  mouths  for  fear  of  offensive  breath,  etc! 
The  length  of  the  human  intestinal  canal  exceeds 
that  of  the  body  by  six  times;  would  we  be  much 
happier  if,  instead,  it  were  like  a  sheep's — twenty- 
eight  times  as  long?  If  in  lieu  of  one,  man  pos- 
sessed four  stomachs  like  a  ruminant"?  When  all  is 
said  and  done,  *'Der  Mensch  ist  was  er  isst,"  a  man 
is  what  he  eats.  And  there  would  not  be  much  to 
rejoice  about  if  he  were  turned  into  a  dull,  cud- 
chewing  brute,  whose  entire  energy  was  absorbed  by 
the  digestive  process. 

If  man  were  to  discard  clothing,  this  would  neces- 
sitate a  tremendous  expenditure  of  energy  on  the 
part  of  the  system  to  increase  our  caloric  out-put, 
and  there  are  really  no  grounds  for  envying  the 
glacial  flea,  which  lives  and  multiplies  upon  the  ice. 

No  one  will  argue  against  such  a  contention.  Of 
course  I  am  far  from  wishing  man  to  become  a 
ruminant  or  a  glacial  flea.  But  no  more  does  it 
follow  that  his  ideal  should  be  an  animated  brain 
specimen  solely  able  to  exist  in  a  hermetically 
sealed  glass  case!  Cultured  man  does  not  mind 
saddling  his  nose  with  spectacles,  losing  his  muscles, 
refusing  "heavy"  food;  but  he  would  be  horrified  at 
the  prospect  of  never  parting  with  a  phial  of  con- 
centrated oxygen,  of  covering  up  his  face  and  hands 
indoors,  having  to  insert  olfactory  discs  into  his  nos- 
trils and  speaking  trumpets  into  his  ears  I 


PROGRESS  AND  DEGENERATION    223 

Here  is  the  whole  matter  in  a  nutshell:  while 
availing  ourselves  of  the  advantages  offered  by  civi- 
lisation, we  must  preserve  the  closest  communion 
with  nature ;  in  developing  various  new  and  positive 
qualities  in  our  organisms,  made  possible  by  our 
civilisation,  we  must  be  jealous  of  our  old  character- 
istics; their  attainment  has  been  won  at  too  great 
a  cost,  while  nothing  could  be  easier  than  to  lose 
them.  Grant  intellect  full  scope  for  its  advance- 
ment but  let  us  have  strong  thews,  keen  organs  of 
sense,  an  active  frame  and  a  hardened  system  too, 
that  we  may  lead  a  natural,  wholesome  life  at  one 
with  nature,  and  not  merely  content  ourselves  with 
resting  in  its  lap  in  the  garb  of  effete  summer 
visitors. 

Only  the  body's  free  and  many-sided  existence  in 
all  the  variety  of  its  functions  and  multiplicity  of 
the  impressions  furnished  by  the  brain,  can  impart 
a  wide  and  energetic  life  to  the  brain  itself. 

"Thy  body  is  thy  greater  mind,  multiplicity  with 
a  single  consciousness,  peace  and  war,  the  herd  and 
the  shepherd." 

"Thy  lesser  reason  is  thy  body's  tool,  oh  my 
brother;  that  little  tool,  that  toy  of  thy  greater 
mind  thou  callest  thy  spirit." 

Thus  spoke  Nietzsche's  Zarothustra^  addressing 
those  who  "despise  the  body."  .  .  .  The  closer  the 
acquaintance  with  the  soul  of  the  so-called  "intel- 
lectual" man,  the  less  attractive  and  satisfying  does 


224    THE  MEMOIRS  OF  A  PHYSICIAN 

that  "lesser  reason,"  which  has  disowned  the 
"greater  mind,"  stand  out  before  us. 

And,  at  the  same  time,  there  can  be  no  doubt 
that  social  evolution  dooms  this  greater  mind  to 
annihilation;  at  any  rate  there  is  nothing  to  lead  us 
to  expect  that  things  will  improve  in  this  respect  in 
the  near  future.  The  promise  of  the  future  social 
emancipation  of  man  is  embodied  in  the  great  city, 
and  only  such  speculations  as  those  indulged  in  by 
Bellamy  have  any  real  foundation. 

This  future,  so  bright  from  the  social  point  of 
view,  is  hopelessly  sinister  and  poor  as  far  as  the 
life  of  the  organism  itself  is  concerned;  everything 
will  tend  to  make  physical  labour  superfluous  and 
bodily  idleness  will  result,  fat  will  take  the  place  of 
muscle,  we  shall  lead  an  unretrospective,  vegetative 
existence,  being  deprived  of  broad  horizons  and 
strangers  to  nature.  .  .  . 

Medicine  may  be  as  insistent  as  it  pleases  in 
pointing  out  to  man  the  necessity  of  an  all-round 
physical  training — all  its  injunctions,  as  far  as  the 
adult  is  concerned,  will  be  effectually  nullified  by 
the  existing  conditions,  as  they  are  set  at  nought  by 
the  cultured  classes  of  to-day.  To  become  strong 
and  vigorous  the  adult  must  work  with  sinews  and 
muscles,  not  merely  exercise  the  latter.  It  is  no 
great  hardship  to  throw  away  daily  two  or  three 
minutes  cleaning  the  teeth  for  hygienic  considera- 
tions,  but   it   would   be    unspeakably    dreary    and 


PROGRESS  AND  DEGENERATION     225 

repugnant  to  waste  several  hours  per  diem  over 
senseless  and  unproductive  gymnastics.  Here  lies 
the  chief  reason  of  the  intellectual  person's  bodily 
flabbiness,  and  not  at  all  in  his  lack  of  appreciation 
of  the  benefits  accruing  from  a  good  physique.  Per- 
sonal experience  convinced  me  of  this. 

In  this  respect  I  was  brought  up  under  exception- 
ally favourable  conditions.  Each  summer,  up  to 
the  close  of  my  University  career,  I  passed  in  the 
country,  living  the  life  of  a  simple  labourer.  From 
m_orn  till  eve  I  ploughed,  mowed,  harvested  and 
felled  timber.  And  how  well  do  I  know  the  bliss 
of  that  hearty,  healthy  fatigue  in  every  muscle,  that 
is  born  of  hard  work  in  the  open,  when  colds  have 
no  terrors;  how  well  do  I  remember  my  ravenous 
appetite  and  sound  sleep.  Even  now,  when  I  am 
able  to  tear  myself  away  from  town,  I  fly  to  the 
country,  again  taking  up  scythe  and  axe;  returning 
to  St.  Petersburg  with  horny  hands,  a  rejuvenated 
body,  a  thirsty  and  joyful  love  of  life.  I  am  not 
theorising.  My  whole  being  cries  to  me  that  the 
soul  stands  in  need  of  energetic  life  of  the  body, 
and  in  its  absence  my  depression  of  spirits  becomes 
almost  ridiculous.  I  passed  last  summer  in  rustic 
surroundings  as  usual:  one  night,  about  a  fortnight 
after  my  return  to  town,  I  woke  from  a  paroxysm 
of  weeping;  some  dream  had  plunged  my  soul  into 
terrible  sadness.  I  tried  to  recollect  my  vision — 
at  first  in  vain— finally  succeeding.     I  saw  myself 


226     THE  MEMOIRS  OF  A  PHYSICIAN 

standing  at  the  edge  of  the  forest,  axe  in  hand;  at 
my  feet  lay  two  birch-trees  just  felled  by  me;  grey 
clouds  straggled  athwart  the  sky  and  a  fresh  and 
bracing  wind  fanned  my  face.  Nothing  more. 
But  my  heaviness  of  heart  remained,  and  the  same 
feeling  of  depression  gripped  it:  as  if  a  glimpse  of 
heaven  had  just  been  granted  me,  to  be  followed 
by  a  sad  awakening  to  reality;  my  summer's  dream 
was  a  thing  of  the  past.  .  .  .  My  limbs  were  suf- 
fused with  an  irritating,  restless  sensation,  as  if 
yearning  for  work;  a  dull  light,  reflected  from  the 
street  lamps,  played  upon  the  ceiling  of  my  bed- 
room, while  the  everlasting,  muffled,  vibrating 
rumble  of  the  unsleeping  city  floated  through  the 
windows. 

And  nevertheless,  when  in  town,  I  cannot  help 
living  the  life  of  a  brain-worker  pure  and  simple. 
At  first  I  try  to  resist,  take  dumb-bell  exercise,  do 
gymnastics,  go  for  long  walks;  but  my  patience  is 
short-lived,  it  succumbs  beneath  the  boredom  and 
senselessness  of  it  all.  And  if,  in  times  to  come, 
our  inherent  craving  for  labour  will  only  find  outlet 
in  sport,  lawn  tennis,  cricket,  gymnastics,  etc.,  all 
the  remonstrances  of  medicine  and  of  our  reason 
itself  will  prove  utterly  powerless  against  the  ennui 
of  such  "work." 

Dostoievsky,  in  his  "Letters  from  the  House  of 
the  Dead,"  describing  enforced  convict  labour  in 
Siberia,  says:     "If  it  were  desired  to  crush  and 


PROGRESS  AND  DEGENERATION    227 

utterly  abase  man,  to  inflict  upon  him  the  most 
awful  punishment,  that  the  most  terrible  murderer 
would  quail  before  and  fear  in  anticipation,  all  that 
would  be  required  were  to  impart  the  character  of 
perfect,  complete  uselessness  and  senselessness  to  his 
work.  If,  for  instance,  the  convict  were  forced  to 
pour  water  fromx  tub  to  tub,  while  another  was  given 
sand  to  pound  in  a  mortar,  and  so  on,  I  think  that 
the  prisoner  w^ould  strangle  himself  after  a  few 
days,  or  else  commit  a  thousand  crimes,  so  as  to 
escape  this  horrible  degradation  and  suffering,  even 
at  the  cost  of  his  life." 

Small  wonder  then  if  the  man  of  the  future  kicks 
all  these  absurd  tubs  aside. 

Thus  life  says:  "Thou  strong  men  with  power- 
ful thews,  sharp  eyes  and  keen  ears,  hardy  and  self- 
sufficient  in  thy  independence,  I  have  no  use  for  such 
as  thou,  that  are  doomed  to  extinction."  .  .  . 

But  the  new  man,  who  is  to  take  his  place,  what 
promise  of  happiness  does  he  hold  out? 


CHAPTER  XV 

SHAME    AND    THE    PHYSICIAN 

jNE  day  a  peasant  v/oman  from  our  village 
came  to  ask  me  to  see  her  daughter  who  was  ill. 

On  entering  their  cottage  I  was  struck  by  the 
sour  and  indescribably  disgusting  stench  pervading 
the  air — just  the  sort  of  smell  as  emanated  from  a 
gully  where  offal  is  cast.  Lying  upon  one  of  the 
low  broad  benches  running  round  the  room,  covered 
with  a  sheep-skin  coat,  was  a  girl  of  seventeen  with 
pale  and  wasted  features. 

"Where  do  you  feel  the  pain'?"  I  asked. 

She  grew  very  red  and  made  no  response,  merely 
staring  at  me  in  a  frightened  way. 

*'Oh,  Doctor  deary,  she's  a-bed  with  an  illness  a 
maid  might  well  be  ashamed  to  show,"  whined  the 
old  woman. 

"What  nonsense!  You  mustn't  be  ashamed  of 
your  doctor  I     Let  me  see  what's  the  matter." 

I  went  up  to  the  girl.  Her  face  suddenly  as- 
sumed a  wooden  expression  of  submission,  while  a 
pair  of  dull  and  scared  eyes  stared  at  me  mutely. 

"Turn    round,    Annie,    let   him   have    a    look!" 

228 


SHAME  AND  THE  PHYSICIAN      229 

coaxed  the  mother,  removing  the  sheep-skin.  "The 
doctor  will  see  what  ails  you,  please  God  he'll  do 
you  good  and  you'll  be  well." 

With  the  same  imbecile  eyes  and  with  a  concen- 
trated, frightened  passiveness,  the  girl  turned  on  her 
side  and  lifted  her  rude  linen  shift,  which  was  stiff 
as  bark  from  dried  pus.  I  grew  faint  from  the  un- 
bearable odour  and  from  the  sight  I  saw.  Her 
entire  left  thigh,  from  waist  to  knee,  was  one  great 
bluish-red  swelling,  corroded  by  sores  and  abscesses 
the  size  of  a  iist,  covered  with  stinking,  decomposing 
matter. 

'Why  didn't  you  send  for  me  before?  Why, 
I've  been  here  for  the  last  six  weeks !"  I  cried. 

"Oh,  deary  Doctor,  she  was  ashamed,  poor  lass," 
sighed  the  old  woman.  "She's  been  ill  more  than 
a  month;  she  thought  it  would  pass  by  itself,  God 
willing;  first  of  all  it  was  just  such  a  little  spot.  .  .  . 
Says  I:  'Annie,  there's  a  doctor  come  to  stay  with 
the  Squire,  all  pray  for  him  for  the  good  he  does — 
go  and  show  him  your  leg."  'Oh  no,  mammy,  I'm 
ashamed.'  ...  Of  course,  she's  a  maid  and  fool- 
ish. .  .  .  And  this  is  what  we've  come  to  I" 

I  hastened  home  to  fetch  my  instruments  and 
bandaging  materials.  .  .  .  My  God,  how  grotesque  I 
Aid  was  to  be  had  for  the  asking  for  the  past  month 
— but  a  clownish,  monstrous  feeling  prevented  her 
from  availing  herself  of  it,  and  only  now,  at  the 
eleventh  hour,  had  she  screwed  up  courage  to  cross 


230     THE  MEMOIRS  OF  A  PHYSICIAN 

this  boundary — now  that  it  was  too  late,  per- 
haps. ... 

Such  cases  are  very  common.  How  many  com- 
plaints are  neglected  by  women  through  this  shame, 
how  many  obstructions  placed  in  the  way  of  the 
doctor's  diagnosis  and  subsequent  treatment !  How 
much  mental  suffering  has  a  woman  to  pass  through 
when  forced  to  overstep  her  shame!  Even  now 
before  me  arises,  as  in  the  life,  the  flurried  face  of 
the  girl,  with  its  suddenly  assumed  expression  of 
vacuity,  and  her  scared  submissive  eyes;  she  must 
have  gone  through  much,  before  she  felt  compelled 
to  waive  her  maidenly  shame  and  apply  to  me. 

When  we  are  subjected  frequently  to  the  same 
impressions  we  become  accustomed  to  them.  Never- 
theless, whenever  a  female  patient  unrobes  in  my 
presence  with  slightly  heightened  colour  and  an  al- 
most imperceptible  tremor,  I  wonder  whether  I 
have  any  true  conception  of  what  her  soul  is  going 
through  at  this  moment*? 

In  "Anna  Karenina"  there  is  a  painful  scene. 
"The  celebrated  doctor,"  writes  Tolstoy,  "a  very 
handsome  and  not  as  yet  an  old  man,  demanded 
an  examination  of  Kitty.  He  seemed  to  insist 
with  special  pleasure,  that  maidenly  shame  was  a 
relic  of  barbaric  times  and  that  nothing  could  be 
more  natural  than  that  a  man,  still  in '  his  prime, 
should  feel  over  a  young  and  bared  girl.  It  was 
necessary  to  submit.  ,  ,  .  After  an  attentive  exam- 


SHAME  AND  THE  PHYSICIAN      231 

ination  and  auscultation  of  the  patient,  who  was 
flurpied  and  stupefied  from  shame,  the  celebrated 
doctor  having  carefully  washed  his  hands,  stood  in 
the  drawing-room  conversing  with  the  prince.  .  .  . 
Her  mother  went  to  Kitty  in  the  drawing-room. 
Thin  and  flushed,  with  a  peculiar  brightness  of  the 
eyes,  owing  to  the  shame  she  had  lately  borne, 
Kitty  stood  in  the  middle  of  the  room.  When  the 
doctor  entered,  her  face  flamed  up  and  her  eyes 
filled  with  tears." 

Patients  gradually  develop  habit  for  such  exam- 
inations; but  it  is  only  attained  at  the  cost  of  the 
painful  scattering  of  the  spiritual  ideology  nurtured 
from  childhood.  By  no  means  do  all  pass  through 
the  mill  unscathed.  I  remember  once  experiencing 
something  akin  to  fear  at  the  sight  of  the  terrible 
denudation  that  such  a  shattering  may  occasionally 
cause  in  the  soul  of  a  woman.  I  was  a  student  at 
the  time  and  on  my  way  to  a  cholera-stricken  dis- 
trict in  the  province  of  Ekaterinoslav.  At  Khar- 
koff,  about  10  P.M.,  a  young  ladylike  woman  got 
into  our  car;  she  had  a  sympathetic  and  pretty  face 
with  clear  naive  eyes.  We  entered  into  conver- 
sation. On  hearing  that  I  was  a  medical  student 
she  told  me  that  she  had  been  to  Kharkoff  for 
the  sake  of  undergoing  special  treatment,  and  forth- 
with launched  into  a  description  of  her  malady: 
a  victim  to  dysmenorrhoea  for  the  last  four  years, 
she  had  consulted  various  professors;  one  diagnosed 


232     THE  MEMOIRS  OF  A  PHYSICIAN 

anteflexion  of  the  uterus ;  another,  constriction  of  the 
colon;  a  month  ago  division  of  the  colon  had  been 
performed  upon  her.  Gazing  at  me  through  the 
gloom  of  the  car  with  limpid  and  serene  eyes,  she 
described  the  symptoms  of  her  complaint  and  told 
me  how  it  had  commenced;  she  initiated  me  into 
the  most  intimate  details  of  her  sexual  and  married 
life,  there  was  nothing  before  which  she  showed 
any  hesitation;  and  all  this — unnecessarily,  with 
no  end  in  view,  even  without  any  questions  on  my 
part!  I  listened  dumfounded:  how  many  revolt- 
ing manipulations  and  inquisitions  must  it  have 
been  her  lot  to  submit  to,  how  long  and  sys- 
tematically must  she  have  been  forced  to  trample 
upon  her  woman's  modesty,  that  this  voluntary  and 
aimless  baring  of  herself  before  the  first  chance 
acquaintance  should  have  become  possible! 

But  if  this  same  shame  of  woman  bore  another 
character — such  outraging  of  her  sensibilities,  and 
the  resulting  spiritual  devastation,  would  not  be 
possible.  In  St.  Petersburg  once  I  had  to  attend 
a  lady  student.  Everything  indicated  typhoid;  the 
spleen  could  be  felt  through  her  chemise,  but  it  was 
necessary  to  bare  her  middle,  that  I  might  see  the 
roseolse.  I  hesitated  for  a  moment — even  now  it 
pains  me  to  proffer  such  requests. 

*'Ah!  you  want  me  to  lift  my  nightgown*?"  the 
girl  asked  quite  naturally,  guessing  what  was  re- 
quired. 


SHAME  AND  THE  PHYSICIAN      233 

She  did  so.  And  this,  which  is  often  so  agonising, 
shameful  and  hard,  proved  wonderfully  easy  and 
simple  I  I  can  hardly  tell  you  what  a  sympathetic 
aspect  this  serious-faced  girl,  with  her  clever  and 
calm  eyes,  acquired  on  the  instant.  .  .  .  I  saw  that 
to  her  what  had  happened  contained  neither  offence 
nor  torture,  because  she  was  cultured  in  the  true 
sense.  But  although  this  baring  of  herself  at  my 
request  was  performed  with  such  ready  and  un- 
conscious simplicity,  I  am  convinced  that,  casually 
met  in  a  railway  carriage,  she  would  never  have  told 
m.e  anything  like  that  otJier  one. 

What  is  shameful  for  the  human  being  and  what 
is  not  shameful*? 

There  are  certain  tribes  that  are  ashamed  to  clothe 
themselves.  When  the  missionaries  distributed 
clothes  to  the  Indians  of  the  Orinoco  River,  to  cover 
their  bodies  with,  the  women  either  threw  them  away 
or  hid  them,  saying:  ''We  do  not  clothe  ourselves 
because  we  are  ashamed."  \\Tiile  in  Brazil,  Wal- 
lace once  found  in  a  hut  several  women  who  were 
absolutely  naked,  but  not  in  the  least  abashed  by 
the  circumstance.  One  of  them  was  provided  with 
a  "saia"  or  kind  of  petticoat,  which  she  occasionally 
donned;  Wallace  tells  us  that  it  was  when  she  had 
it  on  that  she  showed  almost  the  same  shame  as 
would  a  civilised  woman  if  surprised  without  that 
article  of  apparel. 

What  is  shameful?     We  judge  from  a  standpoint 


234     THE  MEMOIRS  OF  A  PHYSICIAN 

that  we  have  acquired  through  the  complex  agency 
of  the  most  varied  and,  often,  entirely  chance, 
causes.  Those  who  are  more  bashful  than  ourselves 
and  those  who  are  less  so,  excite  the  same  con- 
descending smile  of  pity  at  their  "want  of  culture." 
Modesty  forbids  the  oriental  woman  to  expose  her 
face  to  the  male  gaze ;  a  Russian  peasant  woman  re- 
gards it  as  a  shame  to  appear  in  public  with  bare 
head;  the  provincial  ladies  described  by  Gogol 
thought  it  bad  manners  to  say  "I  have  blown  my 
nose,"  substituting  "I  have  made  use  of  my  pocket- 
handkerchief,  I  have  eased  my  nose."  All  this  pro- 
vokes our  laughter,  and  we  are  genuinely  perplexed 
as  to  why  it  should  be  indecent  to  show  one's  face 
or  hair,  or  to  talk  about  blowing  our  noses.  But 
why  does  not  a  woman,  who  is  ashamed  to  bare  her 
knee  or  middle  before  a  man,  excite  our  ridicule. 
How  is  it  that  the  most  modest  girl  does  not  con- 
sider it  indecent  to  expose  the  upper  half  of  her 
breast  at  a  ball,  whereas,  stripped  to  the  waist,  she 
would  be  called  a  brazen  hussy  ^  Why  do  we  not 
feel  shocked  at  the  sight  of  a  man  who  appears  in 
the  presence  of  women  with  uncovered  beard  and 
moustache — for  these  are  undoubtedly  the  secondary 
attributes  of  the  male  ?  There  is  no  harm  in  saying 
"I  have  blown  my  nose,"  but  the  mention  of  certain 
other  physiological  functions,  equally  unsesthetic  it 
is  true,  but  no  less  natural,  is  forbidden.  In  con- 
sequence of  this,   when  in  each  other's  presence, 


SHAME  AND  THE  PHYSICIAN     235 

members  of  the  opposite  sexes  subject  themselves  to 
torment,  frequently  courting  serious  illness  by  not 
daring  to  betray  any  sign  of  wanting  to  perform  that 
without  which,  as  all  know,  we  cannot  exist. 

Our  whole  up-bringing  is  directed  to  the  one  end 
of  making  us  regard  our  bodies  as  something  to  be 
ashamed  of;  we  are  taught  to  consider  a  whole  series 
of  the  most  legitimate  functions  of  our  organisms, 
pre-ordained  by  nature,  not  otherwise  than  with 
shame;  obscoenum  est  dicere,  facer e  non  ohscoenum 
—thus  Cicero  sums  the  matter  up. 

With  the  first  glimmer  of  consciousness,  the  child 
commences  to  receive  persevering  instructions  that  it 
should  be  ashamed  of  such-and-such  functions  and 
of  certain  portions  of  its  body:  the  pure  nature  of 
the  child  is  for  a  long  time  unable  to  grasp  the  mean- 
ing of  these  lessons ;  but  the  efforts  of  its  preceptors 
do  not  relax,  and  at  last  it  commences  to  realise  the 
iniquity  of  its  physical  life.  This  goes  on  for  sev- 
eral years. 

When  the  time  arrives,  the  mystery  of  his  or  her 
origin  is  unveiled  before  the  budding  man  or  woman ; 
and  thanks  to  their  early  training,  the  secret  as- 
sumes the  aspect  of  filth  from  beginning  to  end,  \m- 
speakably  shocking  and  revolting  in  its  unexpected- 
ness. In  some  the  thought  of  the  legitimacy  of  such 
incredible  depravity  calls  forth  a  voluptuous  feel- 
ing; it  plunges  others  into  despair.  The  anguished 
sobs  of  the  young  girl,  who  recoils  at  the  revelation 


236     THE  MEMOIRS  OF  A  PHYSICIAN 

of  t±ie  impurity  of  life,  vowing  never  to  marry,  her 
love  rudely  trampled  into  the  mire — these  are  ele- 
ments for  a  most  serious  and  painful  drama,  which, 
at  the  same  time,  strikes  one  with  its  unnaturalness. 
But  how  were  anything  else  possible  *?  Rousseau 
demanded  that  parents  and  preceptors  should  them- 
selves explain  all  to  their  children  and  charges,  not 
leave  the  task  to  the  unclean  tongues  of  menials  and 
school-fellows.  But  this  would  not  make  the  slight- 
est difference:  the  child's  education  renders  it  in- 
capable of  seeing  these  things  in  any  other  than  the 
most  revolting  light — that  of  horrible  and  shameless 
foulness,  no  matter  how  "purely"  you  put  things 
before  it  I 

Still,  all  this  by  no  means  implies  that  shame 
itself  is  actually  no  more  than  a  survival  of  bar- 
barity, as  Tolstoy's  "celebrated  doctor"  would  have 
it  I  Shame — that  instinct  which  protects  our  in- 
timate life  from  the  stranger's  gaze,  that  feeling 
which  makes  it  impossible  for  the  human  being  to 
give  himself  or  herself  up  to  the  casual  female  or 
male,  is  no  remnant  of  the  barbaric  age,  but  a 
precious  acquisition  of  culture. 

However,  such  pudency  by  no  means  excludes  an 
earnest  and  frank  attitude  towards  the  human  body 
and  its  life.  Bourget,  in  his  "Profils  Perdus"  has 
a  striking  sketch,  in  which  he  describes  a  highly 
educated  young  Russian  girl;  a  rather  shallow 
disciple  of  the  ^'Science  gf  love"  is  utterly  non- 


SHAME  AND  THE  PHYSICIAN      237 

plussed  by  her :  she  discusses  with  him,  "in  terms  of 
scientific  materialism,"  the  subjects  of  conception, 
maternity,  etc.,  with  the  utmost  freedom,  "whilst, 
at  the  same  time,  no  man's  lips  had  ever  so  much  as 
touched  her  hand  I"   .  .  . 

Modesty,  severe  and  chaste,  does  not  even  pre- 
clude nudity.  Buffon  says:  "We  are  neither 
sufRciently  depraved  nor  sufficiently  innocent  to  go 
about  naked."  Is  this  just'?  Savages  are  no  more 
immoral  than  we,  the  fables  about  their  innocence 
have  long  been  exploded;  at  the  same  time,  many 
of  them  go  about  unclothed  and  their  nakedness 
does  not  deprave  them:  they  are  used  to  it — that  is 
alL  More  than  this,  as  we  have  already  seen,  tribes 
exist  that  are  actually  ashamed  to  dress.  Exactly 
as  the  custom  to  clothe  one's  body  may  go  hand  in 
hand  with  the  most  profound  corruption,  so  can 
habitual  nakedness  be  associated  with  the  severest 
chastity.  The  Tierra-del-Fuegan  women  go  about 
stark  naked,  without  being  in  the  least  embarrassed 
by  the  fact;  however,  v\^hen  they  felt  the  lecherous 
glances  of  the  European  sailors  rest  upon  them,  they 
blushed  and  hastened  to  hide  themselves;  probably 
a  fully- attired  European  woman  would  flush  in  the 
same  way,  on  encountering  the  look  of  a  Brazilian 
or  Orinoco  Indian. 

It  is  solely  a  matter  of  what  we  are  used  to.  If 
it  were  only  considered  improper  to  uncover  the 
little  finger,  the  exposure  of  that  part  would  have  a 


238    THE  MEMOIRS  OF  A  PHYSICIAN 

more  potent  effect  upon  representatives  of  the  op- 
posite sex  than  that  of  any  other.  With  us  nearly 
the  whole  of  the  body  is  jealously  concealed  by 
clothing.  The  noble,  pure  and  beautiful  human 
body  is  thus  turned  into  an  allurement  for  perfectly 
definite  ends:  forbidden  and  inaccessible  to  the  eye 
of  the  other  sex,  it  is  only  disclosed  on  specific  oc- 
casions, intensifying  the  voluptuousness  of  these 
moments  and  imparting  to  them  an  added  zest. 
Habitual  nakedness  would  deal  the  first  and  severest 
blow  of  all  to  the  voluptuary.^  We  can  admire  a 
draped  beauty  without  experiencing  any  special 
feeling,  but  our  up-bringing  has  rendered  us  inca- 
pable of  looking  purely  upon  the  nude  body  of  a 
living  woman — even  were  her  form  to  rival  the 
Venus  of  Milo  in  its  perfection  of  shape. 

We  are  ashamed  of  our  body  and  do  not  respect 
it;  all  our  efforts  are  directed  at  ornamenting  it  at 
the  price  of  its  complete  disfigurement.  Special 
albums  entitled  "Le  Nu"  are  annually  published  in 
Paris,  being  collections  of  photo-engravings  from  all 
the  pictures  depicting  the  nude,  exhibited  during  the 

1  In  the  "Klassische  Walpurgisnacht,"  Mephistopheles  felt  himself 
an  utter  stranger:  "Fasst  alles  nackt,  nur  hie  und  da  behemdet,"  he 
grumbled   discontentedly, — "Zwar   sind   auch  wir  von  Herzen  un- 
austandig,  Doch  das  Antike  find'  ich  zu  lebendig."  .  .  . 
In  another  place,  he  remarks: — 

"Was  hat  man  an  den  nackten  Heiden? 
Ich  liebe  mir  was  auszukleiden, 
Wenn  man  doch  einmal  lieben  soil." 
That  refined  voluptuary,  Maupassant,  lingered  with  special  relish 
over  scenes  describing  the  process  of  undressing. 


SHAME  AND  THE  PHYSICIAN     239 

current  year  at  the  art  galleries.  A  glance  through 
such  an  album  is  sufficient  to  frighten  one,  yes, 
actually  fill  one  with  lively  apprehension  for  the 
future  of  mankind — the  mere  sight  of  those  soft, 
flabby  female  figures  with  gigantic  fat  posteriors, 
compressed  sides  and  rudimentary,  prematurely 
pendant  breasts !  Unless  to  speculate  as  to  the  cri- 
teria which  will  in  the  future  determine  the  limits  of 
pudicity,  but  one  thing  is  beyond  doubt — the  man 
will  treat  nature  and  her  ordinances  with  ever  grow- 
ing respect,  ceasing  to  blush  because  he  has  a  body 
which  lives  in  accordance  with  its  appointed  laws. 

But  this  happy  epoch  is  probably  still  very  remote. 
In  dealing  with  the  soul  of  woman  at  present,  medi- 
cine must  exercise  great  gentleness  and  delicacy. 
Until  recently  the  stronger  sex  monopolised  medi- 
cine, and  women  with  the  most  intimate  maladies 
had  to  apply  to  men  for  aid.  Who  will  ever  cal- 
culate the  vast  amount  of  misery  and  outraged  sen- 
sibility this  involves,  count  the  number  of  women 
who  have  perished  because  they  could  not  force 
themselves  to  disclose  their  sufferings  to  a  man*? 
We  men  are  exempted  from  such  trials,  also  being 
less  particular  in  this  respect.  Nevertheless,  some 
strange  things  happen. 

In  1883,  during  the  session  of  a  certain  Zemstvo, 
two  of  its  members  tried  to  get  through  a  proposal 
making  medically-qualified  women  ineligible  as  dis- 
trict  doctors,    "because,"    explained    the    worthies. 


240    THE  MEMOIRS  OF  A  PHYSICIAN 

"male  syphilitic  patients  are  ashamed  to  apply  to 
female  physicians."  This  is  quite  intelligible  to  us : 
not  one  of  us  suffering  from  any  more  or  less  intimate 
complaint  would  willingly  accept  treatment  at  the 
hands  of  a  woman.  But  would  those  excellent 
members  have  had  the  hardihood  to  aver  that  women 
felt  differently  in  the  matter?  If  so,  they  were 
guilty  of  gross  mendacity.  The  reports  of  the  doc- 
tors in  the  employ  of  our  Zemstvos  constantly  draw 
attention  to  the  reluctance  displayed  by  the  peasant 
women,  and  especially  girls,  in  availing  themselves 
of  medical  aid. 

At  the  present  day,  fortunately,  medical  training 
is  placed  within  the  reach  of  women;  this  is  a 
tremendous  boon  to  the  whole  sex  without  distinc- 
tion,— not  only  to  Mussulmen  women,  as  the  cham- 
pions of  medical  education  for  women  are  pleased  to 
point  out.  It  is  a  gigantic  gain  to  science  itself. 
For  only  woman  will  be  able  to  understand  and 
make  her  own  the  obscure  and  terribly  involved  life 
of  the  female  organism  in  its  physical  and  psychical 
entirety;  for  men  this  knowledge  will  ever  remain, 
at  best,  incomplete  and  vague. 


CHAPTER  XVI 

WHEN    THE    PATIENT    DIES 

ABOUT  eighteen  months  after  my  arrival  in 
St.  Petersburg,  I  was  called  in  to  attend  the 
sick  baby  of  an  engine-driver.  The  family  occupied 
a  room  on  the  fifth  floor,  at  the  top  of  a  dirty  and 
malodorous  staircase.  The  engine-driver's  three- 
year-old  boy  had  an  abscess  in  one  of  his  tonsils ;  the 
child  was  rickety,  thin  and  pale;  it  struggled  and 
bit  at  the  spoon,  so  that  I  had  no  little  difficulty 
in  examining  its  throat.  I  prescribed  appropriate 
treatment.  The  father,  a  tall  and  shaggy  man  with 
a  red  beard,  wanted  to  pay  me  when  I  was  about 
to  leave;  the  room  was  wretched  and  squalid  and 
there  were  a  lot  of  children  about,  so  I  declined  to 
take  his  money.  He  respectfully  saw  me  to  the 
door  and  thanked  me. 

For  the  next  two  days  the  child  continued  fev- 
erish, the  swelling  in  the  throat  increased  and 
respiration  grew  difficult.  I  spoke  to  the  parents 
and  proposed  to  lance  the  gathering. 

"  How's  that?     Do  you  mean  that  you  will  cut 

him  inside  *?"  asked  the  mother  apprehensively  and 

suspiciously. 

24X 


242     THE  MEMOIRS  OF  A  PHYSICIAN 

I  explained  that  the  operation  was  quite  safe. 

"No  then!  I  won't  allow  it  I" — she  declared 
with  shrill  decision,  and  my  remonstrances  and  ex- 
planations were  unavailing. 

''I  think  that  the  Lord  knows  best,"  said  the 
father.  "If  God  wills  it  the  boy  will  die,  even  if 
you  do  slit  the  gathering.  Besides,  he's  too  weak  to 
stand  an  operation,  anyway." 

I  said  no  more,  but  began  to  syringe  the  child's 
throat. 

"Why,  he  opens  his  mouth  himself  now,"  re- 
marked the  father  sadly. 

"The  abscess  will  probably  burst  to-day,"  I  said. 
"See  that  the  child  doesn't  choke  in  his  sleep  from 
the  matter.     If  he's  very  bad,  send  for  me." 

I  went  into  the  kitchen.  The  father  sprang  after 
me,  and  began  helping  me  on  with  my  coat. 

"I  don't  know,  Mr.  Doctor,  how  to  thank  you. 
We  shall  be  your  debtors,  in  a  manner  of  speaking, 
for  life!" 

When  I  came  round  again  next  day,  the  bell  was 
answered  by  the  engine-driver's  wife;  her  eyes  were 
red,  her  face  was  pale,  she  cast  a  hard  look  at  me, 
and  withdrew  to  the  kitchen-range  without  a  word. 

"Well,  and  how  is  your  son?"  I  queried.  No 
answer  came.     She  did  not  turn  round  even. 

"Dying,"  muttered  an  old  woman  from  a  corner 
of  the  room. 

I  took  my  overcoat  off,  and  stepped  into  the 


WHEN  THE  PATIENT  DIES        243 

dwelling-room.  The  father  sat  on  the  edge  of  the 
bed,  with  the  pallid  child  lying  on  his  lap.  He 
glanced  at  me  in  a  cold  and  apathetic  way. 

"It's  beyond  me  how  he  lived  till  morning,"  he 
answered  sulkily.     "He'll  be  dead  by  mid-day." 

I  felt  the  little  patient's  pulse. 

"The  matter  came  out  of  his  nose  and  mouth  all 
night  long,"  continued  the  father.  "Sometimes  he 
was  nearly  suffocated — went  blue,  and  turned  his 
eyes  up;  the  wife  would  begin  to  cry  and  shake  him 
— and  he'd  come  round  a  bit." 

"Bring  him  to  the  window,  I  want  to  look  at  his 
throat,"  I  ordered. 

"What's  the  good  of  tormenting  him  any  more^" 
the  mother  angrily  broke  in  just  then.  "Leave  him 
in  peace!" 

"Fie!"  I  cried.  "Your  child  gets  a  little  worse 
and  you  lose  all  hope  and  do  nothing:  let  it  die! 
Why,  he  isn't  really  so  ill  at  all !" 

The  swelling  in  the  throat  had  considerably  sub- 
sided, but  the  boy  was  greatly  exhausted,  and  very 
weak.  I  told  the  parents  that  he  was  doing  very 
well  indeed,  and  would  soon  be  all  right. 

"Lord  grant  it!"  remarked  the  engine-driver  with 
a  sceptical  sneer.  "I  don't  think  you'll  find  him 
alive  when  you  come  to-morrow." 

I  wrote  out  a  prescription,  explained  how  the 
medicine  was  to  be  administered,  and  rose  to  go.- 
"Good-bye !" 


244    THE  MEMOIRS  OF  A  PHYSICIAN 

The  father  hardly  vouchsafed  me  an  answer,  and 
no  one  saw  me  to  the  door. 

I  left  them,  deeply  indignant.  Of  course  their 
grief  was  perfectly  legitimate  and  comprehensible: 
but  what  had  I  done  to  merit  such  treatment  *? 
They  saw  how  much  trouble  I  gave  myself  on  their 
behalf — and  not  a  spark  of  gratitude  I  There  used 
to  be  a  time  when  in  my  dreams  I  pictured  things 
very  differently:  the  patient  died,  but  his  relatives 
had  seen  how  warmly  and  disinterestedly  I  minis- 
tered to  him  in  his  sickness,  and  regarded  me  with 
love  and  gratitude. 

"I'm  not  wanted — so  much  the  better!  I  won't 
call  again,"  I  decided. 

Next  day  I  had  to  bring  all  my  will-power  into 
play  to  force  myself  to  visit  my  little  patient. 
While  in  the  act  of  ringing  I  trembled  with  indigna- 
tion, in  anticipation  of  further  proofs  of  the  sense- 
less, undeserved  hatred  of  those  people  whom  I  was 
doing  all  in  my  power  to  assist. 

I  was  admitted  by  the  mother — rosy,  happy ; 
after  a  momentary  hesitation  she  seized  my  hand 
and  warmly  wrung  it.  I  was  surprised  to  see  what 
a  nice  and  comely  face  she  had — I  never  noticed 
the  fact  before.  The  child  was  getting  on  very  well, 
looked  cheerful  and  asked  for  food.  I  left,  fol- 
lowed by  the  fervent  thanks  of  both  parents. 

This  case  was  the  first  to  show  me  that  if  you 
are  expected  to  save  the  life  of  a  dear  one,  and  you 


WHEN  THE  PATIENT  DIES        245* 

disappoint  such  hopes,  you  will  never  be  forgiven, 
no  matter  how  great  your  pains  may  have  been. 

I  attended  the  young  wife  of  a  certain  merchant, 
Starikoff  by  name,  suffering  from  diphtheria.  Her 
husband,  a  round,  rubicund  little  man  with  a  good- 
natured  face  and  small  yellow  moustache,  used  to 
drive  round  himself  with  his  thorough-bred  "trotter" 
to  fetch  me.  His  fussy,  counter-jumper's  attentions 
embarrassed  and  amused  me  at  the  same  time.  He 
stood  at  my  elbow  when  I  got  into  the  sledge,  then 
arranged  my  fur  coat  about  my  knees,  and  having 
made  me  comfortable,  would  seat  himself  on  the 
very  edge  of  the  cushions.  The  patient  was  stricken 
down  with  a  very  serious,  so-called  phlegmonous 
form  of  the  disease,  and  hovered  on  the  brink  of 
death  for  several  days;  at  last,  however,  she  began 
to  recover.  But  there  was  still  danger  to  be  feared 
from  paralysis  following  on  diphtheria. 

One  morning  I  was  rung  up  at  four  o'clock  by 
my  patient's  husband.  He  told  me  that  his  wife 
had  suddenly  been  seized  with  sickness  and  violent 
pains  in  the  stomach.  We  drove  off  without  delay. 
A  blizzard  was  raging  outside,  and  the  light  sledge 
sped  swiftly  through  the  deserted  streets. 

"What  a  lot  of  trouble  we  do  give  you.  Doctor  I" 
began  my  companion  apologetically.  "Just  think 
of  hauling  you  out  at  such  an  hour  and  in  such 
weather  too,  depriving  you  of  your  sleep !" 

The  sufferer  was  in  a  very  bad  way;  she  com- 


246     THE  MEMOIRS  OF  A  PHYSICIAN 

plained  of  drawing  pains  in  the  chest  and  stomach, 
her  face  was  white  with  that  indescribable  pallor 
which  does  not  even  require  a  very  practised  eye 
to  tell  the  doctor  that  heart  failure  is  rapidly  and 
irresistibly  drawing  near.  I,  accordingly,  warned 
the  husband  of  the  imminence  of  the  danger.  After 
staying  three  hours  with  the  patient  I  left  her  to 
visit  another  serious  case  that  could  not  wait.  An 
experienced  trained  nurse  replaced  me  at  Mme. 
Starikoff's  bedside. 

In  an  hour  and  a  half  I  returned.  The  husband, 
with  altered  face  and  inflamed  eyes,  came  out  to 
meet  me.  He  paused  on  the  threshold  of  the  draw- 
ing-room, and  deliberately  put  his  hands  beneath 
his  coat-tails. 

"Got  anything  nice  to  tell  us?"  he  asked  in  tones 
of  contemptuous  familiarity. 

"How  is  Maria  Ivanovna*?" 

"Maria  Ivanovna,  is  it?"  he  repeated  in  drawling 
accents. 

"Why,  yes." 

He  remained  silent  for  a  moment. 

"She  died  comfortably  half  an  hour  ago!"  sneered 
Mr.  Starikoff,  scanning  me  with  hatred.  "Good- 
day!''  And,  abruptly  turning  on  his  heel,  he  dis- 
appeared in  the  drawing-room,  where  the  deceased's 
relatives  were  assembling. 

My  memory  refuses  to  recognise  the  same  man 
in  these  two  personifications  of  Mr.  Starikoff;  the 


WHEN  THE  PATIENT  DIES        247 

one  fussily  attentive,  obsequious,  hanging  on  my 
words,  the  other — distant,  hostile,  provoking  in  his 
offensive  familiarity  of  manner,  with  red  eyes  burn- 
ing with  hatred.  Oh,  how  such  people  do  hate  I 
Their  hatred  knows  no  bounds.  In  former  times, 
on  like  occasions,  short  was  the  doctor's  shift. 

"A  certain  outlandish  physician,  Anthony  by 
name,^"  we  read  in  the  ancient  Moscovite  chronicles, 
''doctored  Prince  Karakoutsh,  but  took  his  life  with 
poisonous  herbs  because  he  mocked.  Whereas  the 
Great  Prince  Johann  III.  delivered  him  to  the  son 
of  Karakoutsh,  who  tortured  him  and  then  held  him 
up  to  ransom.  Whereas  the  Great  Prince  did  not 
allow  this  to  be  done  but  ordered  his  killing;  and 
they  led  him  in  the  winter  to  the  Moskva  River, 
and  beneath  a  bridge  slaughtered  him  with  a  knife, 
like  a  sheep." 

According  to  the  laws  of  the  Westgoths,  if  a 
doctor's  patient  died,  the  former  was  immediately 
handed  over  to  the  relatives  of  the  deceased,  "that 
they  might  do  what  they  pleased  with  him."  And 
even  nowadays,  many  and  many  sigh  because  these 
cheerful  customs  have  gone  out  of  fashion.  About 
fifteen  years  ago  a  Russian  landowner,  a  certain 
Herken,  lost  his  daughter  whom  one  Dr.  Svintsinsky, 
in  the  employ  of  the  Zemstvo,  had  attended.  Ac- 
cording to  the  provincial  newspapers,  the  be- 
reaved parent  handed  the  Assembly  of  the  Zemstvo 
a  deposition,  in  which  he  stated  that  Dr.  Svintsinsky 


248     THE  MEMOIRS  OF  A  PHYSICIAN 

was  more  ignorant  of  medicine  than  a  common  hos- 
pital attendant,  and  that  the  entire  population  of 
the  district  were  dissatisfied  with  him  because  of  his 
"lack  of  knowledge  and  attention."  A  commission 
of  enquiry  was  nominated.  Herken's  plaint  was 
found  to  be  a  gross  libel,  and  the  Assembly  passed 
a  unanimous  resolution  expressing  gratitude  to  Dr. 
Svintsinsky  for  his  "upright  and  beneficial  labours." 
Towards  the  end  of  1883  the  Novorossisky  Tele- 
graph newspaper,  published  in  Odessa,  printed  a 
letter  by  a  certain  Beliakoff,  under  the  following 
sensational  headline: — 

MY  SON  HAS  BEEN  MURDERED. 

(A  father's  extraordinary  obituary  notice  on  his  son.) 

"Yes,  Mr.  Editor!"  wrote  Beliakoff,  "My  only 
son,  Socrates,  was  scientifically  murdered  in  Kher- 
son, at  the  stroke  of  10  p.m.,  on  the  28th  of  No- 
vember, through  the  agency  of  a  local  operator  called 
Petrovsky."  .  .  . 

And  in  a  lengthy  "feuilleton"  Beliakoff  pro- 
ceeded to  describe  in  minute  detail  how  his  child 
had  been  taken  ill  with  diphtheria,  how  faultily  the 
doctors  attended  it,  and  how  the  affection  extended 
to  the  larynx,  thanks  to  their  neglect.  With  the 
conscientiousness  of  an  examining  magistrate  he 
quoted  all  the  doctors'  orders  and  prescriptions,  as 
evidence  for  the  prosecution,  and  thereby  clearly — 


WHEN  THE  PATIENT  DIES        249 

although  unwittingly — proved  to  all  competent  per- 
sons that  there  was  nothing  to  find  cavil  at.  The 
child  was  in  a  very  bad  way.  One  of  the  doctors 
declared  the  case  hopeless  and  left.  The  father 
implored  that  his  child  should  be  saved.  It  was 
then  that  Dr.  Herschelmann,  who  had  remained, 
proposed  the  last  expedient — an  operation.  During 
the  latter,  which  was  performed  by  Dr.  Petrovsky, 
the  child  died.  As  will  be  seen  from  the  writer's 
own  testimony,  the  case  was  a  very  bad  one,  the 
end  being  possible  at  any  moment:  but  Beliakoff, 
who  was  entirely  incompetent  to  judge,  declared  that 
the  operator  had  simply  "murdered"  his  son.^ 

"Ought  the  operation  to  have  been  performed," 
queried  Beliakoff,  "the  illness  having  lasted  for  six 
days?  Competent  persons  (?)  say  that  when 
diphtheria  has  run  its  course  for  so  long  without 
complications  and  the  patient  still  breathes — there 
can  be  no  need  for  an  operation"  (this  is  absolute 
nonsense).  "Finally,  was  Dr.  Herschelmann's 
treatment  right?  Had  he  employed  all  the  reme- 
dies possible  to  save  the  patient?  In  my  opinion 
Dr.  Herschelmann  treated  the  affair  too  super- 
ficially. .  .  .  After  this  hunt  up  a  paragraph  in  our 

^  In  consequence  of  a  formal  petition  lodged  by  the  father,  the 
child's  body  was  exhumed  and  a  post-mortem  examination  held  in 
the  presence  of  the  examining  magistrate  and  four  experts;  it  was 
clearly  established  that  the  cause  of  the  deceased's  death  was  as- 
phyxiation by  diphtherial  membrane,  the  operation  itself  having 
been  performed  irreproachably. 


250    THE  MEMOIRS  OF  A  PHYSICIAN 

penal  code  that  would  meet  the  case,  and  justly  in- 
flict a  terrible  penalty  upon  the  person  guilty  of 
Socrates'  death,  and  thus  avenge  our  grief!" 

Of  course,  no  paragraph  of  any  penal  code  could 
have  appeased  Beliakoff.  Now,  if  the  laws  of  the 
Westgoths  were  in  force,  no  doubt  the  fond  parent 
would  have  devised  a  penalty  fully  avenging  his 
loss!  The  thirst  for  a  sanguinary  expiatory  offer- 
ing to  the  shade  of  the  dear  departed,  at  any  cost, 
is  very  strong  in  man. 

In  the  beginning,  this  hatred  which  I  had  to  face 
tortured  me  acutely.  I  turned  red  and  suffered 
agonies  whenever  I  chanced  to  meet  in  the  street 
any  one  connected  with  a  defunct  patient,  and  saw 
the  former  hastily  look  away,  so  as  not  to  bow  to 
me.  Little  by  little  becoming  inured  to  such  a 
state  of  affairs,  I  began  to  be  aware  of  an  unlooked- 
for  phenomenon. 

Not  far  from  where  I  lived  resided  a  lady  proof- 
reader, a  certain  Mme.  Dekanoff,  whose  son,  a  pupil 
of  the  Gymnasium,  suddenly  fell  ill.  I  was  recom- 
mended to  her  by  one  of  my  patients  and  she  asked 
me  to  call.  She  lived  in  a  small  fiat  with  her  two 
children — the  sick  boy  and  her  grown-up  daughter 
Katerina  Alexandrovna,  a  prepossessing  girl  with  an 
attractive  and  spifituelle  face — a  student  of  medi- 
cine. It  was  evident  that  both  mother  and  daugh- 
ter worshipped  the  boy.     I  found  him  to  be  suffer- 


WHEN  THE  PATIENT  DIES        2^1 

ing  from  croupous  pneumonia.  The  mother,  a  thin 
and  nervous  woman  with  restless,  psychopathic  eyes, 
was  overwhelmed. 

"Doctor,  tell  me,  is  it  very  dangerous?  Will  he 
die?" 

I  replied  that  it  was  impossible  to  say  anything 
at  present,  that  the  crisis  would  set  in  in  five  or  six 
days.  And  then  began  a  most  trying  time  for  me. 
Neither  mother  nor  daughter  could  for  a  moment 
allow  the  thought  that  their  darling  might  die; 
they  were  ready  to  do  anything  to  save  him.  I  had 
to  visit  the  patient  three  times  a  day;  this  was  en- 
tirely unnecessary,  but  I  was  overborne  by  their  per- 
sistency. 

''Doctor,  oh,  he  is  not  dying,  surely?"  the  mother 
would  ask  in  a  horrified  and  strangled  voice.  "Oh, 
my  dear  Doctor  I  I  am  off  my  head,  forgive  me. 
.  .  .  What  was  it  I  wanted  to  say?  .  .  .  Oh,  yes, 
you'll  do  all  you  can?  You  will  save  my  Vladi- 
mir?" 

On  the  fourth  day  Katerina  Alexandrovna  took 
me  aside;  she  was  much  agitated  and  bit  her  lips, 
seeking  to  control  herself. 

"Don't  take  it  amiss,  but  might  I  speak  to  you 
as  to  a  private  person.  .  .  .  Your  treatment  strikes 
me  as  being  too  commonplace:  baths,  codeine,  cup- 
ping, ice-packs  to  the  head.  .  .  .  Now  you've  pre- 
scribed digitalis."  ... 


252     THE  MEMOIRS  OF  A  PHYSICIAN 

"If  you  think  so,  please  take  matters  into  your 
own  hands — I  will  obey  your  commands,"  I  coldly 
responded. 

"Oh,  no,  I  know  nothing,"  she  hastily  exclaimed. 
"But  I  want  something  out  of  the  common  to  be 
done  that  would  save  our  Vladimir  for  certain. 
Mother  will  go  out  of  her  mind  if  he  dies." 

"You  had  better  find  another  doctor;  I  am  doing 
all  that  I  think  necessary." 

"Oh,  you  misunderstand  me  again.  .  .  .  Forgive 
me,  I  don't  know  what  I  am  saying  myself  I"  she 
finally  broke  off  nervously. 

They  had  hired  an  experienced  professional  nurse 
to  attend  their  patient.  Nevertheless,  hardly  a 
night  passed  without  my  being  rung  up  by  the 
younger  of  the  two  ladies;  the  servant  would  for- 
ward an  urgent  message : — 

"Vladimir  is  worse,  he  is  delirious  and  groaning, 
please  come  round." 

And  I  dressed  and  went  without  demur.  But 
sometimes  my  patience  failed  me. 

"Were  you  sent  by  the  nurse  or  did  you  yourself 
consider  my  presence  necessary  *?"  I  would  ask 
gruffly. 

Her  dark  eyes  flashing  with  indignation,  on  such 
occasions  Katerina  Alexandrovna  could  barely  con- 
trol herself,  seeing  how  I  valued  my  rest. 

"I  f4ncy  a  mere  Sister  of  Mercy  is  no  doctor  and 
incompetent  to  judge." 


WHEN  THE  PATIENT  DIES        2^3 

Saying  no  more,  I  would  enter  the  sick-room. 
The  boy  is  delirious,  tosses  about  fitfully,  his  breath- 
ing is  rapid,  but  the  pulse  good  and  there  is  no  need 
to  alter  anything.  The  nurse  sits  at  the  window 
in  a  huff.     I  silently  go  into  the  hall. 

"What's  to  be  done?"  asks  Katerina  Alexan- 
drovna.     ''His  pulse  is  growing  faint." 

"Continue  treatm.ent  as  hitherto.  The  pulse  is 
excellent,"  I  answer  moodily,  and  close  the  door 
behind  me.  And  on  my  way  home  I  reflect  that  if 
I  had  to  attend  such  a  patient  daily  for  a  year,  my 
constitution,  no  matter  how  robust,  would  be  utterly 
worn  out. 

Next  day  the  boy  feels  better  and  his  sister's  eyes 
gaze  upon  m.e  affectionately  and  caressingly. 

In  fact,  without  seeing  the  patient,  I  always  un- 
erringly guessed  how  he  was  by  the  expression  of 
Katerina  Alexandrovna's  eyes  when  she  opened  the 
front  door;  if  he  were  worse,  her  face  breathed  ill- 
concealed  dislike ;  if  he  were  better,  her  eyes  beamed 
upon  me  with  infinite  tenderness. 

The  crisis  was  very  stormy.  For  two  days  the 
boy  hovered  between  life  and  death.  During  that 
period  I  was  hardly  outside  the  Dekanoffs'  flat. 
Twice  I  held  consultations.  The  mother  looked 
quite  crazed. 

"Doctor,  save  him!  .  .  .  Doctor!" — And  tightly 
clutching  my  elbow  with  her  bony  fingers,  she  peered 
fixedly  into  my  face  with  eyes  that  were  both  piteous 


254    THE  MEMOIRS  OF  A  PHYSICIAN 

and  supplicatory,  and  at  the  same  time  terrible  and 
full  of  hatred;  as  if  she  sought  to  make  me  fathom 
the  abyss  of  anguish  his  death  would  plunge  her 
into. 

The  boy,  with  bluish  and  motionless  face, 
breathed  hurriedly  and  thickly,  his  pulse  was  hardly 
perceptible.  I  completed  my  auscultation  and  lift- 
ing my  head,  caught  the  hungry  look  of  the  dis- 
tracted, awful  eyes  of  the  mother. 

The  patient  survived  the  crisis  and  rallied.  Two 
days  later  he  was  out  of  danger.  Mother  and 
daughter  came  to  my  house  to  express  their  thanks. 
Oh,  Lord,  what  gratitude  was  theirs. 

''Doctor,  darling!  Our  dearest  friend!" — the 
mother  kept  on  repeating  in  ecstasies.  "Can  you 
realise  what  you  have  done  for  me*?  .  .  .  No,  you 
cannot!  Oh,  God,  how  can  I  express  myself? 
When  I  die  I  will  think  of  you  alone!  I  have 
vowed  it  to  Our  Lady  of  Sorrow.  .  .  .  Oh,  what 
can  I  do  to  thank  you  sufficiently,  I  am  under  a  life- 
long obligation  to  you.     Doctor,  forgive  me."  .  .  . 

And  she  tried  to  seize  my  hand  to  kiss  it. 
Katerina  Alexandrovna,  her  profound  and  beautiful 
eyes  streaming,  clasped  my  hand  in  both  of  hers. 

While  I — I  looked  at  both  these  women,  trans- 
figured by  this  ecstatic  gratitude,  and  seemed  to  de- 
tect a  vanishing  reflection  of  that  hatred  which  had 
gleamed  in  those  same  eyes  three  days  ago. 

They  departed,  I  resumed  the  book  which  their 


WHEN  THE  PATIENT  DIES        255 

advent  had  made  me  lay  aside.  And  suddenly  it 
struck  me  how  cold  all  their  thanks  had  left  me;  it 
was  as  if  a  tiresome  tempest  of  words,  empty  as 
chaff,  had  passed  over  my  soul,  not  one  of  them 
finding  its  way  to  my  heart.  Was  this  myself  who 
had  once  upon  a  time  imagined  that  such  moments 
as  those  were  our  reward,  the  "bright  rays  of  light" 
which  illuminated  the  sombre  and  hard  life  of  the 
physician"?  *'What  bright  rays  were  these "?" 
Undying  hatred  would  have  been  my  reward  for  the 
same  pains  and  strenuous  desire  to  save  the  boy — 
if  he  had  died. 

Gradually  I  grew  accustomed  to  that  hatred  and 
became  indifferent.  And  as  an  unexpected  con- 
sequence of  this,  complete  coldness  to  gratitude  fol- 
lowed of  its  own  accord. 

And  the  conviction  took  ever  deeper  and  deeper 
root  that  in  general  it  was  first  of  all  necessary  to 
develop  in  oneself  a  profound  and  utter  indifference 
to  the  feelings  of  the  patient.  Otherwise,  despair 
and  grief  would  drive  one  mad  twenty  times  over. 


CHAPTER  XVII 


"the  professional  manner' 


VERILY,  we  must  steel  our  hearts  and  rise  su- 
perior to  suffering,  despair  and  hatred,  con- 
templating each  patient  as  an  irresponsible  being, 
powerless  to  deal  us  any  insult.  Secure  in  the 
armour  of  such  a  philosophy,  I  will  go  dispassion- 
ately to  the  engine-driver  I  spoke  of  in  the  forego- 
ing chapter,  and  the  thought  of  his  unjust  hatred  will 
be  powerless  to  make  me  falter  on  the  threshold. 
"Indifference,  indifference  I"  This  was  the  watch- 
word I  ever  repeated  to  myself. — But  oh !  how  hard 
it  was  to  acquire ! 

I  recently  attended  the  young  wife  of  a  civil- 
service  functionary.  Her  husband,  with  a  nervous 
and  intellectual  face  and  queer  thin  voice,  informed 
me  in  a  panic  that  his  wife  was  very  ill — probably 
with  diphtheria.  Examination,  however,  showed  it 
to  be  merely  a  case  of  ulcerated  sore  throat. 

"It  isn't  dangerous,  is  it*?"  queried  the  husband. 

"No.  Very  probably  it  will  be  over  in  a  day  or 
two,  although  it  is  possible  that  an  abscess  may 
form." 

J?56 


"THE  PROFESSIONAL  MANNER"     257 

Two  days  later  a  gathering  actually  did  appear 
in  the  left  tonsil. 

"Why  should  an  abscess  begin  to  form^"  enquired 
the  husband. 

Why!  As  if  any  one  could  answer  such  a  ques- 
tion. 

Both  husband  and  wife  showed  me  the  confiding 
and  charming  trust  that  is  so  stimulating  and  is 
so  valued  by  the  doctor.  My  every  direction  was 
carried  out  to  the  letter,  almost  religiously.  For 
five  days  the  patient  was  in  great  pain  and  hardly 
able  to  open  her  mouth  or  swallow.  After  I  had 
incised  the  swelling  several  times,  it  subsided  and 
the  patient  began  to  recover  rapidly ;  however,  some 
muscular  pain  still  remained  on  either  side  of  the 
neck  and  I  applied  myself  to  massage  the  affected 
parts  softly. 

"How  delicately  and  gently  you  do  everything!" 
the  patient  said  with  a  blushing  smile.  "Really  I 
wouldn't  mind  being  ill  always  to  be  attended  by 
you." 

I  used  to  remain  to  coffee  every  day,  in  com- 
pliance with  their  kindly  insistent  invitations,  often 
chatting  with  them  for  an  hour  on  end.  I  expe- 
rienced great  pleasure  in  the  friendly  and  almost 
affectionate  way  this  couple  treated  me. 

Two  days  later  the  patient  began  to  feel  pains  in 
the  right  side  of  her  throat  and  her  temperature  went 
vp  again* 


258     THE  MEMOIRS  OF  A  PHYSICIAN 

''What  can  it  be?"  asked  the  alarmed  husband. 

"Probably  a  gathering  is  forming  in  the  right 
tonsil  too." 

"Oh,  dear!  Another!"  moaned  the  lady,  drop- 
ping her  hands  on  her  lap. 

Her  husband  opened  his  eyes  wide. 

"But  why  should  this  happen?"  he  enquired  with 
astonishment.  "We  seem  to  have  done  all  that 
could  be  done !" 

I  explained  the  impossibility  of  stemming  the 
natural  course  of  the  malady. 

"Oh,  my  poor  little  girl!"  he  exclaimed  nerv- 
ously.    "So  we  must  go  through  it  all  once  more!" 

And  I  plainly  detected  in  his  tone  a  note  of  anger 
directed  against  myself. 

The  abscess  ripened  with  provoking  slowness, 
notwithstanding  my  lancing  it  twice.  Once  more 
the  patient's  throat  swelled  and  swallowing  became 
difficult.  I  noticed  the  daily  increasing  coldness  of 
both  husband  and  wife,  and  the  thickening  of  an 
atmosphere  of  genuine  detestation  of  myself.  I 
now  experienced  an  unpleasant  feeling  whenever  I 
called.  I  was  pained  when  I  had  to  examine  the 
silent  patient  and  issue  my  orders — the  husband 
trying  not  to  look  me  in  the  face  while  I  spoke. 
At  the  same  time  their  former  kindly  manner 
towards  me  gave  place  to  a  species  of  exaggerated 
and  punctilious  politeness;  their  distrust  and  an- 
tipathy could  be  plainly  felt,  although  concealed 


"THE  PROFESSIONAL  MANNER"     259 

beneath  a  veneer  of  civility,  which  did  not  give  me 
a  chance  of  coming  to  an  understanding  and  throw- 
ing up  the  case.  At  bottom,  there  was  not  even  any 
real  distrust;  I  was  merely  the  personification  and 
accompaniment  of  the  tiresome  illness  that  had  ex- 
hausted our  patience  all  round,  and  as  such,  had  be- 
come hateful  and  odious. 

At  last  the  patient  got  well.  Superficially  our 
parting  was  very  cordial,  but  when,  a  week  later, 
I  encountered  the  husband  in  the  lobby  of  the 
theatre,  his  countenance  suddenly  assumed  a  pre- 
occupied expression,  and,  averting  his  face,  he  rap- 
idly passed  by,  pretending  not  to  have  seen  me. 

Yes,  we  must  harden  our  hearts  and  not  let  such 
treatment  hurt  us,  because  it  is  part  and  parcel  of 
our  vocation.  But  frequently,  especially  when  deal- 
ing with  incurable  chronic  cases,  all  the  force  of 
habit,  all  the  efforts  of  one's  will,  cannot  stand  up 
before  the  wild  onslaughts  of  the  despairing  invalid's 
fierce  hatred  for  his  doctor.  It  is  the  doctor's  high- 
est bliss  to  get  rid  of  such  a  patient,  but  often,  all 
his  detestation  notwithstanding,  the  latter  will  cling 
to  his  medical  adviser  with  tenacity,  declining  to  be 
shaken  off.  A  few  years  ago  the  following  affair 
took  place  in  Italy,  not  far  from  Milan.  Dr. 
Franchesco  Bertola  attended  a  certain  consumptive 
cobbler  in  the  last  stages  of  the  disease.  Seeing 
his  condition  ever  growing  worse,  the  tradesman 
lost  all  patience  and  began  to  abuse  his  physician 


26o     THE  MEMOIRS  OF  A  PHYSICIAN 

every  time  the  latter  called,  cursing  him  for  a  quack, 
an  ass,  an  ignoramus,  etc.  Assuring  himself  of  the 
irradicable  hatred  of  the  man,  Dr.  Bertola  declined 
to  treat  him  further.  His  decision  threw  the  cob- 
bler into  a  frenzy.  Waylaying  the  doctor  next  day 
in  the  street,  he  asked:  "Will  you  resume  your  at- 
tendance of  my  case  or  not*?" — and  on  receiving 
a  negative  answer,  thrust  a  butcher's  knife  into  the 
doctor's  stomach.  The  unfortunate  man  fell  down 
mortally  wounded,  the  assassin  sinking  to  the  ground 
simultaneously,  blood  gushing  from  his  mouth. 
The  murderer  and  his  victim  were  immediately 
picked  up  and  conveyed  to  the  same  hospital,  where 
they  both  died. 

A  doctor's  life  is  made  up  of  moments  of  terrible 
nervous  tension,  which  almost  without  intermission 
beat  at  his  heart  like  sledge-hammers.  A  sudden 
turn  for  the  worse  in  a  convalescent  patient,  an  in- 
curable who  cries  for  relief,  the  impending  death  of  a 
patient,  the  ever  present  possibility  of  an  untoward 
accident  or  mistake,  finally,  the  whole  atmosphere 
of  suffering  and  sorrow  that  surrounds  one — all 
these  hold  the  soul  in  an  everlasting  thraldom  of  ill- 
defined,  unappeasable  alarm.  We  are  not  always 
conscious  of  this  mental  condition.  But  perhaps  a 
red-letter  day  dawns  when  all  goes  smoothly:  no 
deaths,  the  patients  are  all  getting  on  well,  you  are 
treated  with  cordiality — and  only  then  does  the 
resulting  sensation  of  deep  relief  and  restfulness  sud- 


"THE  PROFESSIONAL  MANNER"     261 

denly  bring  home  the  realisation  of  that  terrible  state 
of  nervous  strain  that  you  habitually  live  in. 

There  are  times  when  the  powers  to  continue 
such  a  life  are  entirely  exhausted  and  you  are  seized 
with  such  depression  that  only  one  thought  remains 
— to  turn  your  back  on  all  and  flee  far  from  the 
madding  crowd  and  feel,  if  only  for  a  time,  free 
and  at  peace. 

Man  cannot  always  live  at  such  a  pace  and  I 
am  beginning  to  develop  certain  salutary  habits.  I 
no  longer  feel  the  sting  of  my  patients'  hate  and 
injustice  as  of  yore,  my  heart  is  not  cut  to  the  quick 
by  their  sufferings  and  the  sight  of  their  helpless- 
ness. Serious  cases  are  especially  instructive  to  a 
doctor;  formerly  I  could  not  grasp  how  it  was  that 
my  hospital  colleagues  were  so  eager  to  take  over 
the  wards  with  "interesting"  bad  cases;  I,  on  the 
contrary,  did  my  best  to  eschew  such  invalids.  I 
was  pained  at  the  sight  of  their  shrivelled  bodies 
with  scaling  flesh  and  polluted  blood,  to  meet  their 
gaze  mutely  praying  for  the  assuagement  of  their 
torment— while  I  could  do  so  little  for  them. 
Time  brought  habit. 

Small  wonder  that  I  should  be  gradually  evolving 
an  attitude  towards  my  patients  which  is  a  thing 
entirely  apart:  I  am  kind  and  considerate  towards 
them,  trying  to  give  their  needs  my  full  attention, 
conscientiously  doing  all  I  can  for  them;  but  "out 
of  sight,  out  of  mind."     At  home,  in  the  circle  of 


262     THE  MEMOIRS  OF  A  PHYSICIAN 

my  friends,  I  chat  and  laugh:  if  I  am  called  to  a 
patient,  I  go,  do  what  has  to  be  done,  perhaps  com- 
fort the  mother  weeping  over  her  dying  son;  but  on 
my  return  I  at  once  resume  my  former  humour,  and 
the  shadow  of  the  past  does  not  obtrude  itself  on 
the  present.  To  me  the  "patient,"  with  whom  I 
have  to  deal  professionally,  has  nothing  in  common 
with  any  ordinary  sick  person.  However,  leaving 
intimate  friends  out  of  the  question,  it  suffices  for 
such  a  sick  person  to  be  a  mere  acquaintance,  and 
I  am  capable  of  sharing  his  sufferings;  but  in  my 
official  capacity  this  faculty  is  ever  becoming  more 
and  more  atrophied,  so  much  so,  indeed,  that  I  can 
fully  understand  a  friend  of  mine,  a  surgeon  (the 
most  humane  of  men),  who  asks  the  patient,  shriek- 
ing beneath  his  knife,  with  perfectly  genuine  as- 
tonishment: "Funny  man,  why  make  such  a  row?'* 
I  also  understand  how  Pirogoff,  with  his  respon- 
sive and  sensitive  heart,  could  have  been  guilty  of 
the  revolting  sally  he  mentions  in  his  memoirs. 
"Only  once  in  all  my  practice  did  I  make  such  a 
gross  mistake  in  my  examination  of  a  patient,  that 
on  performing  lythotomy,  I  could  find  no  stones  in 
the  bladder.  This  was  in  the  case  of  a  timid  and 
God-fearing  old  man;  greatly  vexed  at  my  false 
stroke  I  was  indelicate  enough  to  send  the  exhausted 
patient  to  the  devil  repeatedly.  'You  have  no  fear 
of  God,'  he  said  in  a  languid,  supplicating  voice, 


"THE  PROFESSIONAL  MANNER"     263 

'if  you  invoke  the  unclean  evil  spirit  when  only  the 
name  of  the  Lord  can  alleviate  my  anguish  I'  " 

It  is  a  strange  peculiarity  of  the  human  heart 
that  it  should  so  often  become  hardened  in  a  definite 
and,  frequently,  very  narrow  groove,  remaining  in 
other  respects  unchanged.  Formerly  such  things 
were  beyond  my  understanding;  now,  however,  I  am 
convinced  that  a  gaoler  or  executioner  is  capable 
of  warmly  responding  to  all  that  is  good,  if  only  it 
lies  beyond  his  professional  sphere. 

In  dealing  with  my  patients  I  am  not  guided  by 
my  immediate  feelings,  but  by  the  promptings  of  my 
reason.  This  gives  me  breathing  space.  But 
when  personally  I  come  across  the  same  attitude  in 
others,  I  cannot  help  experiencing  a  feeling  of  in- 
dignation. 

My  sister  arrived  in  my  house  from  the  provinces ; 
she  had  been  a  municipal  school-teacher,  but  was 
forced  to  resign  two  years  previously,  owing  to  ill- 
health:  overwork  had  completely  exhausted  her 
nervous  system,  and  her  weakness  was  such  that  she 
lay  in  bed  for  days  and  nights,  the  peal  of  a  bell 
called  forth  convulsions,  she  could  not  sleep  at  all 
and  had  become  embittered,  irritable  and  trivial. 
Two  years'  nursing  had  done  her  no  good,  so,  as  a 
last  hope,  she  decided  to  see  a  specialist  of  the 
metropolis.  I  did  not  recognise  her,  she  had  grown 
SO  thin  and  pale,  her  eyes  had  become  large,  bluish 


264    THE  MEMOIRS  OF  A  PHYSICIAN 

circles  were  pencilled  round  them  and  they  burned 
with  a  strange  nervous  lustre. 

Formerly  so  full  of  energy  and  thirst  for  work, 
now  she  was  lackadaisical  and  apathetic.  I  took  her 
to  see  a  celebrated  neuropathologist. 

We  had  long  to  wait,  for  his  consulting-room  was 
thronged.  At  last  we  were  shown  into  his  study. 
The  professor,  with  a  merry  face,  upon  which  in- 
difference was  writ  large,  began  to  interrogate  my 
sister;  he  nodded  his  head  at  each  answer  and  said: 
"Very  good!"  Then  he  sat  down  to  write  out  a 
prescription. 

"Can  I  hope  for  a  cure?"  asked  my  sister,  and 
her  voice  caught. 

"Oh,  of  course,  of  course!"  came  the  genial  re- 
joinder. "Thousands  suffer  from  the  same  com- 
plaint, of  course  you'll  get  well!  We'll  order  you 
baths  twice  a  week,  then."  .  .  . 

I  was  experiencing  a  feeling  of  ever-increasing  dis- 
like for  the  merry,  nonchalant  face,  and  that  tone, 
with  which  it  is  customary  to  address  little  children. 
He  did  not  know  that  there  was  tragedy  in  the  air: 
six  months  earlier,  on  entering  my  sister's  room  by 
chance,  her  mother  had  wrenched  from  her  grasp  a 
phial  of  morphia,  with  which  she  was  on  the  point  of 
poisoning  herself,  not  wanting  to  di^g  out  the  exist- 
ence of  a  useless  parasite.  .  .  .  And  wc  had  to  listen 
to  this  odious  tone,  accompanied  by  that  no  less 


"THE  PROFESSIONAL  MANNER"     26^ 

odious  freedom  of  manner,  that  so  plainly  denoted 
how  little  this  drama  concerned  the  outsider. 

My  sister  stood  silent  and  big  tears  coursed  down 
her  cheeks  unheeded;  proud,  she  was  angry  to  be 
unable  to  suppress  them  and  they  fell  all  the  faster. 
Her  great  grief  had  been  vulgarised  and  belittled — 
for  were  there  not  thousands  such  as  she? — and  the 
magnitude  of  her  affliction  struck  no  one.  .  .  .  To 
think  that  she  had  anticipated  such  great  things 
from  the  interview ! 

"Tut,  tut,  young  lady  I  That  will  never  do!" 
exclaimed  the  professor  at  the  sight  of  her  weeping. 
"Dear,  dear,  dear,  what  a  shame!  Crying!  Com- 
pose yourself,  compose  yourself." 

And  once  more  his  entire  manner  proclaimed  that 
the  professor  daily  saw  dozens  of  such  hysterical 
patients,  and  that,  for  him,  these  tears  were  but 
drops  of  saline  fluid  secreted  from  the  lachrymal 
glands  by  shaky  nerves. 

We  left  in  silence,  and  silently  took  our  place  in 
our  cab.  My  sister  bent  forward,  buried  her  face  in 
her  muif,  and  suddenly  broke  into  sobs,  vainly  and 
angrily  trying  to  smother  them. 

"I  won't  take  any  of  his  foolish  medicines!"  she 
cried,  tore  out  his  prescription  and  reduced  it  to 
shreds.  I  did  not  protest;  in  my  heart  I  felt  like 
her,  having  lost  all  faith  in  the  efficacy  of  the  treat- 
ment prescribed  by  that  nonchalant,  self-complacent 


266     THE  MEMOIRS  OF  A  PHYSICIAN 

man,  who  cared  so  little  for  the  afflictions  of  his  fel- 
low-creatures. 

And  that  same  evening  I  thought:  'Where 
then  shall  I  discover  the  true  line  of  demarcation  be- 
tween patient  and  physician  which  will  make  exist- 
ence possible  to  both,  and  shall  I  always  be  able  to 
keep  to  that  line? 


CHAPTER  XVIII 

DOCTORS    AND    MONEY 

ONE  night  I  heard  my  bell  pulled  violently. 
The  servant  informed  me  that  I  was  begged  to 
visit  a  patient.  A  tall  pimple-faced  young  man, 
wearing  the  cap  of  a  post-office  clerk,  stood  in  the 
hall. 

* 'Doctor,  please  come  at  once  to  see  a  lady  who 
has  suddenly  been  taken  ill  I"  he  burst  forth  in  an 
agitated  voice.  "She's  dying.  .  .  .  It's  quite  near 
by — ^just  round  the  corner."  .  .  . 

I  hastily  dressed  and  we  started  off  together. 

*'What  has  happened  to  your  patient'?  Has  she 
been  ill  long*?"  I  asked  my  companion. 

He  shrugged  his  shoulders  in  perplexity. 

"I  simply  can't  understand  it !  My  God  I  She's 
the  wife  of  a  fellow  employee  and  I  am  their  paying 
guest.  Last  night  they  returned  home  from  seeing 
some  friends,  and  she  laughed  and  joked.  While 
a  short  time  ago  her  husband  woke  me  up,  saying 
that  she  was  dying,  and  sent  me  after  you.  I'm 
quite  at  a  loss  to  say  how  it  all  happened  I" 

We  climbed  up  to  the  fourth  floor  along  a  dark 

and  steep  staircase,  lighting  our  way  with  matches, 

267 


268     THE  MEMOIRS  OF  A  PHYSICIAN 

My  guide  rang  sharply.  A  dark  young  man  with 
a  small  black  beard,  in  his  shirt  sleeves,  opened  the 
door. 

"Doctor.  For  God's  sake!"  he  sobbed,  "quick I" 
He  led  me  into  a  bedroom.  Upon  a  broad  double 
bed,  with  her  head  bent  towards  the  wall,  lay  the 
motionless  form  of  a  young  woman.  I  felt  her 
pulse:  her  hand  was  cold  and  limp,  there  was  no 
flutter  in  her  wrist;  I  turned  the  young  woman 
on  to  her  back,  lifted  her  eyelids,  sounded  her 
heart.  She  was  dead.  I  slowly  straightened  my- 
self. 

"Well?"  asked  the  husband. 

I  shrugged  my  shoulders  regretfully. 

"Dead  I"  he  cried  in  a  choking  voice,  and  sud- 
denly, staring  at  me  with  fixed  and  protruding  eyes, 
began  to  sob  quickly  and  jerkily,  with  a  queer,  bark- 
ing sound.  It  seemed  as  if  his  eyes  had  become 
rooted  into  me  and  he  continued  to  shake  and  sob  in 
the  same  strange,  jerky  fashion. 

"Try  to  calm  yourself.  .  .  .  Nothing  can  be 
done!"  I  said,  placing  my  hand  on  his  arm.  He 
sank  heavily  into  a  chair,  and  swaying  his  body  to 
and  fro,  seized  his  head  in  his  hands.  A  young  girl 
clad  in  a  night-jacket  and  worsted  petticoat,  who 
had  been  standing  by  the  chest  of  drawers,  began  to 
cry  audibly. 

The  dead  was  growing  cold.  Young  and  beauti- 
ful, draped  in  a  laced  nightgown,  she  lay  upon  the 


DOCTORS  AND  MONEY  269 

bed  among  the  crumpled  sheets  which  still  seemed 
to  retain  their  warmth. 

"How  did  it  all  take  place*?"  I  asked. 

"She  was  quite  well!"  the  husband  cried  stri- 
dently. "We  returned  home  from  a  party  yester- 
day. I  woke  up  in  the  night  and  saw  her  lying  on 
her  side.  I  touched  her  shoulder,  she  was  cold  and 
did  not  move.  Oh,  God,  God,  God !"  he  repeated, 
pulling  his  hair.  "Oh,  oh,  oh!  what  does  it  all 
mean^" 

My  companion  shook  his  head  in  pitying  depreca- 
tion. 

"There  now,  old  man!  Serge!  We  can't  help 
it  now !"  he  remonstrated  in  a  sad  and  supplicating 
voice.  "It'^s  God's  will!  You  remember  the 
Tsheprakoffs,  the  same  thing  happened  to  them ;  we 
are  helpless  before  the  Lord's  will." 

"But  oh!  Only  a  minute  or  so  ago.  Na- 
astenka!     Nastia!  .  .  ." 

The  girl  dressed  and  went  out  to  send  the  house- 
porter  for  the  mother  of  the  deceased.  The  friend 
continued  to  console  the  young  widower.  There 
was  nothing  further  for  me  to  do,  so  I  rose  to  go. 
The  husband  seemed  to  wake  up. 

"One  moment,  Doctor,  just  one  moment,  pray!" 
he  said  hurriedly. 

And  continuing  to  sob,  he  hastened  to  open  a 
drawer  of  the  bureau  and,  after  rummaging  about  a 
little,  handed  me  three  roubles. 


270    THE  MEMOIRS  OF  A  PHYSICIAN 

"If  you  please,  no  I"  I  said  with  a  frown,  putting 
his  hand  from  me. 

"But,  Doctor,  how  is  this?  Why  not"?  No,  no, 
please."  I  had  to  accept  the  fee.  I  returned  home 
feeling  both  pained  and  offended;  those  three  rou- 
bles burned  my  pocket:  what  a  harsh,  brutal  disso- 
nance they  were  in  the  presence  of  this  terrible 
bereavement !  I  pictured  my  wife  dying  before  my 
eyes  in  the  same  way  and  could  not  imagine  myself 
hunting  for  a  few  miserable  coins  to  pay  the  doctor ! 
Even  if  we  were  angels,  this  necessity  of  paying  for 
our  services  at  moments  when  one  would  look  to  see 
the  whole  world  stand  still  for  grief,  were  sufficient 
in  itself  to  breed  sentiments  of  animosity  and  ab- 
horrence towards  us  medical  men.  I  experienced 
these  on  contemplating  my  role  in  the  abstract. 

Oh,  that  money!  What  a  time  it  took  me  to 
become  more  or  less  used  to  these  payments !  Your 
every  step  is  marked  by  a  rouble,  the  ring  of  the 
rouble  ever  intrudes  itself  between  you  and  suffering 
man.  What  complications  does  it  not  cause,  how 
often  it  interferes  with  one's  work  and  ties  one's 
hands.  ... 

I  was  especially  weighed  down  in  the  beginning 
by  the  very  system  which  governs  the  appraisement 
of  the  services  rendered  by  the  physician.  We  are 
paid  for  treatment^  no  matter  whether  we  cure  or 
not.     In  the  present  state  of  our  science  no  other 


DOCTORS  AND  MONEY  271 

arrangement  were  feasible,  but,  nevertheless,  it 
struck  me  as  grotesque  and  absurd  that  payment 
should  be  made  for  work  that  had  accomplished 
no  useful  end.  About  three  years  ago  a  certain 
French  doctor  of  Lyons  treated  a  lady  with  in- 
trauterine injections  of  iodine;  the  patient  getting 
no  better,  her  husband,  a  rich  man,  instead  of  dis- 
charging his  doctor's  bill,  sued  him  for  10,000  francs 
damages  for  the  alleged  injury  done  his  wife's 
health.  The  Court  found  for  the  defendant  and 
condemned  the  plaintiff  to  pay  the  doctor  six  hun- 
dred francs  for  his  attendance,  ''because  the  phy- 
sician had  employed  a  remedy  sanctioned  by  science^ 
and  was  not  therefore  responsible  for  the  inefficacy 
of  his  treatment^ 

But  then,  again,  wherein  lies  the  guilt  of  the 
patient  who  applies  to  the  physician  for  aid  and  i3 
obliged  to  pay  him  for  the  questionable  pleasure  of 
undergoing  a  course  of  inefficacious  treatment  ac- 
cording to  the  methods  "sanctioned  by  science"  ? 

Sganarelle,  in  Moliere's  "Le  Medicin  Malgre 
lui,"  remarks:  "Je  trouve  que  c'est  le  metier  le 
mcilleur  de  tous  {i.e.  medicine)  car,  soit  qu'on  fasse 
bien,  ou  soit  qu'on  fasse  mal,  ou  est  tou jours  paye  de 
meme  sorte.  La  mechante  besogne  ne  retombe 
jamais  sur  notre  dos,  et  nous  taillons  comme  il  nous 
plait  sur  I'etoffe  ou  nous  travaillons.  Un  cordon- 
nier,  en  faisant  des  souliers,  ne  saurait  gater  un 


:^72     THE  MEMOIRS  OF  A  PHYSICIAN 

morceau  de  cuir  qu'il  n'en  paye  les  pots  casses,  mais 
ici  I'on  peut  gater  un  homme  sans  qu'il  en  coute 
rien."  ^ 

There  is  much  mordant  truth  in  these  words, 
spoken  by  Sganarelle,  as  in  Moliere's  remarks  on 
doctors  in  general.  Only  that  there  is  really  no 
cause  for  merriment:  we  have  before  us  once  more 
one  of  those  involved  and  painful  incongruities  with 
which  the  physician's  work  is  so  monotonously  re- 
plete. 

The  Lyonnais  tribunal  found  that  the  doctor 
accused  had  "employed  a  remedy  sanctioned  by 
science  and  was  not  therefore  responsible  for  the 
inefficacy  of  his  treatment."  Moliere  ironically 
remarks  through  the  lips  of  the  soubrette  Toinette 
(see  "Le  malade  imaginaire")  : — 

"Cela  est  plaisanti  ils  sont  bien  impertinents  de 
vouloir  que  vous  autres  messieurs,  vous  les  gueris- 
siez!  Vous  n'etes  point  aupres  d'eux  pour  cela; 
vous  n'y  etes  que  pour  recevoir  vos  pensions  et  leur 
ordonner  des  remedes:  c'est  a  eux  a  guerir  s'ils 
peuvent."  ^     And  we  medical  men  are  compelled  in 

1  **I  find  that  It  {i.e.  medicine)  is  the  best  trade  of  all,  because 
whether  you  do  your  work  well  or  ill,  you  are  paid  the  same.  Fail- 
ure is  never  visited  on  our  backs  and  we  cut  the  material  upon 
which  we  are  working  as  we  please.  If  a  cobbler,  in  making  a 
pair  of  shoes,  spoils  a  p'ece  of  leather,  he  must  pay  for  the  damage, 
while  here  one  may  spoil  a  man  without  its  costing  anything." 

2  "This  is  pleasant!  they  are  very  impertinent  to  wish  you,  other 
gentlemen,  to  cure  them!  You  do  not  attend  them  for  that  purpose; 
you  are  only  there  to  receive  your  fees  and  to  prescribe  remedies: 
their  affair  to  get  well,  if  they  can!" 


DOCTORS  AND  MONEY  273 

all  seriousness  to  give  the  same  answer  that  Moliere's 
caricatured  doctor  Diafoirus  made  to  Toinette: 
"Cela  est  vrai.  On  n'est  oblige  qu'a  traiter  les  gens 
dans  les  formes."  ("That  is  true.  One  is  only 
obliged  to  treat  people  according  to  the  forms.") 
Exactly— we  are  obliged  to  treat  patients  in  ac- 
cordance with  the  rules  of  science.  And  no  fault 
of  ours  that  these  should  be  so  imperfect.  If  a 
physician  were  only  paid  for  successful  treatment, 
he  would  not  waste  time  in  undertaking  that  of  any 
more  or  less  serious  case,  there  being  no  guarantee 
for  a  cure. 

When  I  started  on  my  medical  career,  every  fee  I 
received  made  me  feel  most  unhappy.  This  money 
seemed  a  stain  on  my  noble  vocation,  and  its  accept- 
ance lowered  me  in  my  own  estimation.  It  struck 
me  as  incredible  that  the  doctors  of  Western  Europe 
should  have  arrived  at  the  cynicism  of  sending  bills 
to  their  patients.^  A  bill  for  medical  attendance! 
Just  as  if  a  doctor  were  a  tradesman  and  his  minis- 
trations to  the  patient  could  be  assessed  in  guineas, 
francs  or  marks,  as  so  much  grocery  I  Like  Vol- 
taire's ideal  doctor,  I  never  pocketed  a  fee  without 
regret  and  availed  myself  of  every  excuse  for  de- 
clining it.     During  the  first  two  years  of  my  life  in 

3  In  Russia  it  is  customary  to  pay  the  doctor  upon  each  visit; 
etiquette  requires  that  his  fee  should  be  handed  to  him  in  as  unob- 
trusive a  manner  (generally  in  the  act  of  shaking  hands)  as  pos- 
sible, every  one  paying  according  to  his  means.  One  may  accept 
the  average  fee  paid  to  the  family  doctor,  by  people  in  the  middle 
statioo^  of  life,  at  three  roubles  (about  $1.50).— Translator. 


274    THE  MEMOIRS  OF  A  PHYSICIAN 

St.  Petersburg  I  hired  a  room  in  a  family.  My 
landlady  often  sought  my  professional  advice  and 
at  first  invariably  handed  me  my  fee. 

"Please  don't  mention  it!  It  is  quite  unneces- 
sary!" I  would  exclaim  in  an  offended  voice,  and 
forced  the  money  back  into  her  palm. 

Hiding  a  smile,  she  returned  it  to  her  pocket, 
while  I  left  her  airy,  cosy  bedroom  for  my  own  dark 
and  narrow  den  next  the  kitchen,  and  resumed  my 
copying  at  1 5  kopecks,  or  about  eight  cents  per  page, 
of  some  technical  specification  or  other,  to  eke  out 
my  rent. 

In  ancient  Russia  the  monkish  physicians  of  those 
days  took  no  money  for  their  ministrations.  In  my 
opinion,  the  same  principle  ought  to  be  the  key-note 
of  the  high  office  of  every  doctor.  Pay  is  but  a  sad 
necessity,  and  the  less  the  pecuniary  question  ob- 
trudes itself  in  the  physician's  and  patient's  relations 
the  better;  for  it  frequently  places  both  parties  on  a 
false  footing,  often  simply  tying  the  physician's 
hands.  Suppose  the  patient  improves,  but  still  re- 
mains weak  and  needs  careful  watching;  his  friends 
politely  intimate  that  he  being  better,  thank  God, 
there  is  no  need  for  my  further  attendance,  and  that 
they  hope  that  I  will  be  so  kind  as  to  call  should  he 
grow  worse  again.  Of  course  I  ought  to  say,  "I 
must  still  continue  in  attendance — for  you  are  in- 
competent to  judge  as  to  when  the  patient  may  stand 
in  need  of  my  aid." 


DOCTORS  AND  MONEY  275 

But  this  would  also  mean  "continue  to  pay  me 
for  my  visits."  So  you  do  not  give  the  only  answer 
proper  under  the  circumstances  and  leave  the  patient 
to  his  fate. 

When  I  read  in  the  newspapers  of  a  doctor  suing 
his  patient  in  court  for  fees  due,  I  blushed  for  a 
profession  numbering  such  persons  in  its  ranks;  I 
vividly  pictured  the  plaintiff  as  a  greedy  skinflint 
to  whom  human  suffering  merely  represents  so  many 
pounds,  shillings  and  pence.  Why  had  he  chosen 
the  profession  of  a  doctor^  He  were  better  suited 
to  become  a  merchant,  a  contractor  or  a  pawnbroker. 

Then  the  turmoil  of  life  closed  over  my  head.  I 
became  more  intimately  acquainted  with  the  rela- 
tions subsisting  between  faculty  and  laity,  came  to 
know  my  comrades  better.  And,  by  degrees,  my 
former  views  underwent  considerable  modification. 
One  of  my  colleagues  was  a  specialist  for  massage. 
For  two  years  he  had  been  in  constant  attendance 
upon  a  rich  merchant's  family.  The  merchant,  who 
was  highly  educated  and  quite  the  gentleman,  owed 
my  friend  about  two  hundred  roubles.  Half  a  year 
passed.  Being  hard  pressed  for  money,  my  comrade 
wrote  a  polite  note  to  the  man  of  commerce,  beg- 
ging for  a  settlement.  The  merchant  brought  the 
money  round  in  person,  apologising  profusely. 

"Pray  excuse  me.  Doctor!  It  was  so  awkward 
of  me  to  have  kept  you  waiting  so  long.  You  know 
— all  my  time  has  been  taken  up  with  urgent  affairs, 


276    THE  MEMOIRS  OF  A  PHYSICIAN 

it  is  sometimes  possible  to  forget!  Please  forgive 
me — I  am  much  to  blame !" 

But  all  the  while  he  addressed  my  friend  as 
"Doctor" — not  in  the  more  genial  Russian  way  of 
Christian  name  and  patronymic,  and  took  the  great- 
est pains  to  express  himself  with  that  excessive 
civility  which  masks  a  feeling  of  aversion. 

And  from  that  time  forward  my  colleague  saw  no 
more  of  him.  Of  course  the  merchant  did  not  con- 
sider it  bad  form  to  present  bills  for  payment  and 
accounts  for  settlement,  in  the  ordinary  way  of  busi- 
ness; but  a  doctor,  a  doctor  who  mixed  money  up 
with  his  vocation.  .  .  .  Such  a  doctor,  in  his  eyes, 
did  not  stand  at  the  summit  of  his  profession. 

The  behaviour  of  the  merchant  impressed  me 
considerably  and  gave  food  for  deep  thought.  Un- 
becoming and  senseless,  it  was  nevertheless  founded 
upon  that  high  ideal  of  the  physician  which  I  also 
shared.  In  the  merchant's  opinion,  a  doctor  should 
be  ashamed — of  what"?  Of  the  circumstance  that 
he  also  had  to  eat  and  clothe  himself — that  he  also 
requires  payment  for  his  services! 

We  ought  to  give  our  entire  energy  to  society 
gratis — but  who  are  these  disinterested  and  self- 
abnegating  people  themselves,  who  consider  that 
they  have  the  right  to  demand  this  sacrifice  of  us? 

I  emphatically  assert  that  a  doctor  has  no  less 
right  to  claim  what  is  due  to  him,  than  a  journey- 
man— and  need  feel  no  shame  therein !     Let  him  do 


DOCTORS  AND  MONEY  277 

so  openly  and  in  the  face  of  all  men,  instead  of 
covertly  pocketing  his  fee,  as  if  it  were  a  shameful 
and  illegal  bribe !  Just  because  the  world  has  seen 
a  few  bright  examples  of  self-sacrificing  and  dis- 
interested physicians,  it  wishes  all  doctors  to  be 
philanthropists.  No  doubt  such  an  arrangement 
would  be  highly  desirable,  but  still  better — if  society 
were  entirely  made  up  of  ideal  people !  The  aver- 
age doctor  is  also  an  ordinary  average  man,  and  to 
apply  a  higher  standard  to  him  than  the  thousand 
were  unjust.  If  he  declines  to  toil  without  reward, 
what  right  have  those,  who  place  a  very  shrewd  and 
nice  value  upon  their  own  efforts,  to  brand  him  as 
mercenary  ? 

Not  so  very  long  ago  Mr.  ''M.  G."  told  the  read- 
ers of  the  Son  of  the  Fatherland  newspaper  about 
an  acquaintance  who  was  anxious  to  have  a  certain 
doctor  who  had  sued  him  for  his  fee  shown  up. 

"Why  didn't  you  pay  him?"  asked  the  journalist. 

"Well,  you  know,  summer  was  coming  on,  I  had 
to  think  about  the  sea-side,  summer  things  for  the 
children,  and  the  like."  .  .  . 

Such  is  the  reverse  of  the  medal  called  society's 
high  ideal  of  the  true  doctor !  He  must  be  a  disin- 
terested champion — well,  and  we,  plain  mortals,  can 
go  to  the  sea-side  and  take  our  holidays  at  his  ex- 
pense.    A  colleague  told  me  the  following  story: — 

"A  lady  called  on  me  with  the  request  to  see  her 
son,  who  was  ilL     I  went  and  was  shown  into  a 


278     THE  MEMOIRS  OF  A  PHYSICIAN 

small  but  very  cosy  and  pretty  flat;  her  son,  a 
schoolboy,  was  down  with  typhoid.  I  enquired 
whether  she  had  taken  any  one  else's  advice  pre- 
viously.    The  mother  made  a  disdainful  grimace. 

'Oh,  yes,  Dr.  was  in  attendance.  .  .  .  Please 

tell  me.  Doctor,  why  there  are  so  many  heartless  and 

sordid  men  in  your  profession"?     This  Dr. 

came  to  see  Basil  once.  When  I  asked  him  to  come 
a  second  time,  he  said  there  was  no  necessity,  as  he 
knew  what  was  the  matter  and  could  prescribe  what 
was  required  at  a  distance,  without  a  personal  in- 
terview.' .  .  . 

"Agreeing  with  her  that  this  was  not  at  all  nice, 
I  examined  the  boy,  gave  all  necessary  directions 
and  was  about  to  leave.  The  mother  saw  me  to  the 
door,  thanked  me  and  .  .  .  that  was  all!  Shook 
hands,  said,  'Thank  you  so  much' — and  there  the 
matter  ended.  Three  days  later  she  came  again  to 
call  me  to  her  son. 

"I  said  that  I  knew  all  about  his  malady  and 
could  write  out  a  prescription  without  seeing  him. 

"The  lady  took  the  prescription,  rose,  boiling 
with  indignation,  and  left  without  saying  'Good- 
day.'  " 

Of  course  this  lady  afterwards  enlarged  with  heat 
and  at  length  upon  the  rapacity  of  "our  doctors." 
The  way  in  which  such  people,  fully  convinced  of 
their  own  righteousness,  circulate  their  stories,  is 
quite  extraordinary — no  less  than  the  sympathetic 


DOCTORS  AND  MONEY  279 

listening  the  public  gives  them.  In  No.  248  of  the 
Riga  Messenger  for  1892,  the  following  letter  to  the 
editor  was  published: — 

"On  the  21st  of  September  of  this  year,  I  asked 

Dr. to  my  house  to  see  my  daughter  who  was 

ill.     After  remaining  ten  minutes  with  the  patient 

Dr.  left,  promising  to  call  again  next  day. 

He  was  paid  one  rouble  for  his  visit  (fifty  cents). 
Half  an  hour  after  his  departure  my  daughter  re- 
ceived his  visiting  card  with  the  following  inscrip- 
tion :  'Madam  I  In  view  of  your  not  being  in  any 
danger  I  advise  you  to  apply  in  future  to  a  doctor 
living  nearer  you.  I  do  not  visit  patients  for  less 
than  three  roubles  and  do  not  receive  them  in  my 
house    for    less    than    two. — Yours    respectfully, 

(Signed)    L.  Gordon.     Dr,  would  do  well, 

when  advertising  himself  in  the  newspapers,  to  sub- 
join a  scale  of  his  charges.  At  any  rate  he  would 
not  then  be  disappointed  in  his  calculations. 
(Signed)  A.  Ivanoff." 

In  an  answering  letter,  Dr.  wrote  as  fol- 
lows:— "The  value  of  a  doctor's  services  cannot  on 
each  occasion  be  adequately  appraised  by  a  fee 
fixed  for  once  and  for  all.  A  sleepless  night  passed 
at  the  bedside  of  a  poverty-stricken  patient  is  always 
rewarded  by  the  consciousness  of  a  duty  fulfilled; 
in  attending  the  wealthy,  a  doctor  is  justified  in  ex- 
pecting pecuniary  remuneration  porportionate  to  the 
trouble  taken. 


28o     THE  MEMOIRS  OF  A  PHYSICIAN 

"Undoubtedly  a  doctor  has  many  sacred  duties 
to  perform  towards  his  brothers;  but,  at  the  same 
time,  certain  obligations  towards  the  physician  de- 
volve upon  the  patient  or  his  friends.  ...  I  will 
now  pass  on  to  a  case  in  my  practice.  On  September 
2 1st  of  the  current  year  I  was  requested  to  come 
'immediately'  to  see  a  patient  living  in  Kurmanoff 
Street,  in  the  Moscow  'Vorstadt,'  which  I  did  as  soon 
as  I  possibly  could.  I  remained  at  the  patient's  bed- 
side exactly  as  long  as  I  considered  the  case  required, 
not  hurrying  in  the  slightest.  On  returning  home 
I  paid  the  cabman,  whose  fare  swallowed  the  larger 
half  of  my  honorarium.  It  is  perfectly  true  that 
I  was  not  satisfied  with  the  remnant  of  my  rouble 
fee  that  was  left  me.  In  view  of  the  minuteness  of 
the  treatment  the  chronic  malady  of  the  patient 
would  have  entailed,  I  decided  to  make  known  to 
her  my  terms,  which  she  was  at  liberty  to  accept  or 
reject." 

This  case  is  very  characteristic.  Mr.  Ivanoff — 
mark  you,  a  man  of  means — makes  a  doctor  come 
to  his  house  "immediately"  from  the  other  end  of 
such  a  large  city  as  Riga,  and  remunerates  him  for 
the  time  he  has  lost  with  thirty  or  forty  kopecks 
(15  to  20  cents).  Not  content  with  this,  he  pil- 
lories the  unhappy  physician,  not  himself,  on  a 
charge  of  rapacity.  A  newspaper  prints  the  letter 
and  its  readers  cry  the  doctors  down.  .  .  . 

On  the  strength  of  his  belonging  to  the  medical 


DOCTORS  AND  MONEY  281 

profession,  the  everyday  doctor  does  more  good  and 
displays  more  disinterestedness  than  other  people. 
Let  us  suppose  that  the  bread-winner  of  a  family 
lies  dangerously  ill,  starvation  stares  his  wife  and 
children  in  the  face — the  doctor  attends  the  sick  man 
gratis.  Without  a  doubt,  no  person  pretending 
more  or  less  to  decency  would  exact  payment  under 
those  circumstances.  The  difference  lies  in  that  the 
laymen  would  not  take  money^  while  the  physician 
actually  does  not;  and  although  it  may  not  strike  us 
at  first  sight,  this  distinction  is,  nevertheless,  very 
great.  For  the  ordinary  average  mortal  a  good  ac- 
tion is  something  out  of  the  common  and  very  rare 
— for  the  average  doctor  it  is  part  of  the  day's  work. 
Most  doctors  have  free  consulting  hours  for  the  poor ; 
in  most  towns  the  hospitals  have  their  "Out-patient 
relief"  days,  when  the  needy  can  obtain  medical  ad- 
vice for  nothing,  and  there  is  never  a  lack  of  medical 
men  volunteering  their  services  gratis.  According 
to  calculations  made  by  Professor  Sikorsky,  the  chief 
hospitals  of  Kiev  (those  of  the  Red  Cross,  the 
Pokrovsky  Sisterhood,  etc.)  dispensed,  during  1895, 
more  than  138,000  free  consultations.  If  each  of 
these  be  valued  at  twenty-five  kopecks  {i.e.^  about 
12  cents),  and  if  we  allow  that  all  private  consul- 
tations both  at  the  doctors'  and  at  the  patients' 
homes  were  charged  for,  it  will  nevertheless  be 
found  that  the  donations  to  the  poor  of  the  two  hun- 
dred odd  medical  men  resident  in  Kiev  annually 


282     THE  MEMOIRS  OF  A  PHYSICIAN 

amounts  to  about  thirty-five  thousand  roubles  (i.e. 
roughly  $17,500).  How  much  a  year  do  you  give 
away  in  alms,  reader? 

If  members  of  all  professions, — lawyers,  civil 
functionaries,  manufacturers,  landowners,  mer- 
chants,— in  the  exercise  of  their  respective  vocations, 
did  as  much  for  the  poor  as  we  doctors  do,  the  whole 
question  of  providing  for  the  destitute  would,  to  a 
certain  extent,  lose  its  acuteness.  In  actuality  doc- 
tors are  expected  to  be  disinterested,  while  as  for 
the  rest — the  rest  may  content  themselves  with  ex- 
acting this  virtue  from  the  medical  faculty. 

About  twenty  years  ago  Kiev  was  the  scene  of  the 
following  affair.  A  certain  Dr.  Protsenko  was 
called  to  a  patient  whom  he  examined,  but  on  learn- 
ing that  the  sick  man  could  not  afford  a  fee,  took 
his  departure  without  prescribing. 

The  doctor  was  prosecuted  and  condemned  to  a 
fine  and  a  month's  arrest  in  the  guard-room.^  A 
numerous  public  that  filled  the  court  greeted  the 
sentence  with  applause. 

Every  one  will  allow  that  Dr.  Protsenko's  act  was 
despicable;  but  the  psychology  of  the  public,  which 
so  warmly  approved  of  the  sentence  and  afterwards 
complacently  went  home,  also  presents  considerable 
interest.  In  dispersing,  it  discussed  the  hard- 
hearted rapacity  of  doctors  in  general,  but  it  never 

*  This  is  the  mildest  form  of  incarceration,  after  "domiciliary  ar- 
rest," existing  in  Russia,  and  does  not  leave  the  same  stigma  as 
ordinary  imprisonment  in  gaol. — Translator. 


DOCTORS  AND  MONEY  283 

for  a  moment  entertained  the  thought  of  coming  to 
the  aid  of  the  poor  fellow  who  had  been  the  cause 
of  Protsenko's  condemnation,  with  so  much  as  a 
penny.  I  will  suppose  that  that  poor  man  was 
given  to  logical  and  consequential  thought.  He 
goes  up  to  one  of  the  public  and  says : — 

"As  you  have  just  heard,  the  fact  that  I  am  poor 
and  did  not  have  the  wherewithal  to  pay  my  doctor 
was  established  in  court  without  any  room  for 
doubt;  you  will  have  no  difficulty  in  guessing  that 
I  not  only  stand  in  need  of  medical  attendance,  but 
also  require  food:  further — ^my  children  are  starv- 
ing too.     So  just  hand  over  two  or  three  roubles." 

"First  of  all,  my  friend,  if  you  use  that  tone,  I 
will  give  you  nothing,"  answers  the  gentleman 
addressed,  rather  taken  aback  by  such  sans  gene. 
"However,  if  you  ask  me  politely,  I  may  perhaps 
give  you  five  kopecks  for  the  salvation  of  my  soul; 
take  them  and  pray  for " 

"No,  I  don't  beg,  but  I  demand,  and  not  the  gift 
of  a  paltry  five  kopecks,  but  at  least  a  couple  of 
roubles.  A  doctor's  fee  amounts  to  about  that 
much,  and  you  have  just  seen  what  was  done  to  one 
of  them  for  declining  to  help  me  (why,  you  your- 
self applauded  his  conviction!).  If  you  don't  fork 
out  those  roubles,  I'll  see  you  put  into  the  dock  too." 

The  outraged  gentleman  of  course  calls  a  police- 
man and  gives  the  impudent  rascal  in  charge,  the 
public  warmly  sympathising  with  such  a  proceeding. 


284     THE  MEMOIRS  OF  A  PHYSICIAN 

At  the  police  station  the  luckless  one  discovers  that 
logical  thought  does  not  always  pay,  that  a  doctor 
may  be  locked  up  for  his  lack  of  charity,  whereas 
the  rest  of  the  community  enjoy  the  undisputed 
right  of  disposing  of  their  purses  and  time  according 
to  their  tastes.  For  declining  to  succour  a  man 
dying  of  starvation  they  only  have  their  own  con- 
sciences to  "square,"  and  provided  these  be  tough 
enough,  find  it  possible  to  carry  their  heads  proudly, 
in  the  enjoyment  of  universal  esteem. 


CHAPTER  XIX 

DOCTORS    AND    THE    LAW 

(the  physician  in  Russia) 

^^rip^HE  first  duty  of  every  physician  is  to  be 
X  humane  and  on  all  occasions  to  stand  ready 
to  afford  active  assistance  to  people  of  all  classes 
suffering  from  illness.  Therefore  every  physician 
is  bound  to  come  to  the  assistance  of  such  patients 
as  summon  him.  Whosoever  fails  to  comply  here- 
with without  being  able  to  show  special  legitimate 
impediment  thereto,  is  liable,  for  such  neglect  and 
disrespect  for  suffering  humanity,  to  a  fine  not  ex- 
ceeding one  hundred  roubles  and  to  arrest  lasting 
from  seven  days  to  three  months.'* 

So  proclaimeth  Article  81  of  the  Medical  Statutes 
and  Articles  872  and  1522  of  the  Russian  Penal 
Code.  It  were  vain  to  ransack  the  Body  of  Laws 
of  the  Russian  Empire  for  any  other  instances  in 
which  people  are  legally  obliged  to  be  "humane" 
and  which  appoint  penalties  for  "disrespect  for  suf- 
fering humanity."  Such  legal  demands  are  only 
presented  to  doctors.  But  is  it  possible  that  human 
suffering  begins  and  ends  in  sudden  illness,  which 
alone  demands  immediate  succour*?     The  homeless 

285 


286    THE  MEMOIRS  OF  A  PHYSICIAN 

waif  may  freeze  to  death  on  the  steps  of  an  unten- 
anted house,  may  die  of  hunger  before  the  windows 
of  a  baker's  shop — and  the  law  will  serenely  des- 
patch the  body  to  the  mortuary  of  the  nearest  police 
station,  contenting  itself  with  a  statement  as  to  the 
cause  of  death.  The  owners  of  house  or  bakery 
have  nothing  to  fear;  it  is  no  business  of  theirs  to 
be  philanthropic  and  to  display  respect  for  the  suf- 
ferings of  their  fellows.  But  if  a  doctor,  worn  out 
by  his  day's  work  and  a  sleepless  night,  declines  to 
go  to  a  patient,  the  law  appears  upon  the  scene  and 
casts  the  "inhuman"  physician  in  gaol. 

It  is  impermissible  to  leave  those  suddenly  taken 
ill  without  succour.  If  doctors  were  allowed  to 
decline  a  summons,  it  might  be  impossible  to  obtain 
help  in  a  moment  of  emergency.  We  will  suppose 
that  a  dear  one  of  ours  is  in  imminent  and  deadly 
peril.  We  fly  for  the  doctor;  he  meets  us  in  the 
hall,  with  his  mouth  full  of  beefsteak,  and  coolly 
says:  "I  am  at  supper  and  will  afterwards  go  to 
bed;  it  is  too  late — try  elsewhere."  In  another 
place  we  are  told  that  the  doctor  is  out;  in  a  third, 
that  he  is  at  cards  and  disinclined  to  come.  While 
we  are  hunting  about  the  town  for  assistance,  the 
patient  dies,  although  timely  aid  might  have  saved 
him.  Ought  not  these  doctors  be  held  responsible 
for  his  death  and  do  they  not  merit  imprisonment? 

If  we  applied  the  same  logic  to  the  owners  of 
untenanted  houses  and  bakers  they  would  have  to 


DOCTORS  AND  THE  LAW         287 

be  considered  responsible  for  the  homeless  state  of 
the  destitute  and  the  hunger  of  the  starving.  Only 
children  can  settle  social  problems  in  such  an  off- 
hand and  short-sighted  fashion.  People  should  not 
be  suffered  to  die  of  hunger,  or  to  freeze  to  death, 
in  the  public  streets;  but  it  lies  with  society,  as  a 
body,  to  organise  relief  and  not  to  throw  the  re- 
sponsibility upon  the  shoulders  of  individual  land- 
lords merely  because  they  have  unoccupied  houses, 
and  upon  bakers  because  bread  happens  to  be  their 
article  of  commerce.  The  poor  man  should  not  be 
allowed  to  die  without  medical  aid,  it  ought  not  to 
be  possible  for  people  to  fail  in  their  searches  for  a 
doctor  at  night,  but  society  should  itself  provide  for 
such  contingencies,  organising  a  body  of  doctors  for 
night  duty  and  supporting  a  special  medical  staff 
for  ministering  to  the  poor.  In  England,  France 
and  Germany  the  laws  obliging  medical  men  to  ap- 
pear at  the  patient's  first  call  and  to  attend  the  poor 
gratis  have  long  been  repealed. 

In  its  egoism  our  society  is  undesirous  of  burden- 
ing itself  with  superfluous  cares;  it  transfers  their 
entire  weight  from  its  own  shoulders  to  those  of 
single  individuals  and  severely  punishes  the  latter 
when  they  decline  to  carry  the  burden  imposed  upon 
them.  The  injustice  of  such  a  state  of  affairs 
strikes  one  forcibly ;  but  as  it  is  profitable  to  society, 
it  remains  unnoticed,  and  is  wilfully  ignored.  And 
after  having  shirked  its  plain  duties,  society  is  filled 


288    THE  MEMOIRS  OF  A  PHYSICIAN 

with  noble  indignation  when  those  upon  whom  it 
has  shifted  their  weight  carry  them  out  with  insuffi- 
cient alacrity.  The  result  is  an  incredible  state  of 
affairs:  people  seem  to  lose  their  understanding  of 
the  simplest  things,  the  bare  discussion  of  which 
were  something  to  be  ashamed  of;  and  one  asks 
oneself  in  perplexity  how  is  it  conceivable  that 
moral  blindness  should  be  capable  of  reaching  such 
extremes'? 

For  instance  this  is  what  A.  P ff  wrote  in  the 

Novo  ye  Vremya  (No.  8098)  : — 

"Can  one's  teeth  ache  at  night  or  on  holidays*? 
It  would  appear  that  they  cannot,  judging  from  what 
I  am  told  by  the  person  who  has  complained  to  me. 
We  often  blame  the  doctors  when  at  night  they 
flatly  decline  to  go  to  a  patient,  or  do  so  with 
reluctance;  while  the  majority  of  dentists,  upon  the 
strength  of  some  incomprehensible  custom,  enjoy  a 
kind  of  special  privilege  to  rest  on  holidays  and  not 
to  allow  themselves  to  be  disturbed  at  night.  The 
patient  applied  to  several  dentists  and  was  unable  to 
see  any  of  them." 

The  above  paragraph  is  transcribed  by  me  with 
perfect  accuracy;  it  positively  contained  the  expres- 
sions: "a  kind  of  special  privilege"  and  "incompre- 
hensible custom."     In  regard  to  any  other  toiler, 

would  the  tongue  of  the  same  A.  P ff  dare  turn 

to  frame  the  opinion,  that  to  rest  on  holidays  and 
not  to  allow  oneself  to  be  disturbed  at  night  is  an 


DOCTORS  AND  THE  LAW  289 

incomprehensible  custom'?     In  regard  to  his  own 

person,  it  is  hardly  likely  that  A.  P ff  would 

consider  such  a  custom  as  so  very  incomprehensible. 

I  had  a  college  comrade  named  Petroff.  Upon 
taking  his  degree  he  entered  the  service  of  the 
Zemstvo  as  physician  in  an  out-of-the-way  district 
of  one  of  the  Eastern  provinces,  and  I  lost  sight  of 
him. 

A  couple  of  years  ago  the  newspapers,  first  those 
of  the  provinces,  afterwards  those  of  Moscow  and 
St.  Petersburg  as  well,  published  a  revolting  case, 
the  hero  of  which,  so  it  happened,  was  this  comrade 
of  mine. 

In  the  village  of  N ,  so  wrote  the  papers,  the 

elder  of  the  commune  was  taken  ill  after  eating 
some  putrid  fish.  He  sent  to  the  neighbouring 
hamlet  for  the  Zemstvo  doctor,  Petroff.  Petroff 
despatched  his  dispenser  instead  of  coming  himself. 
The  patient  became  worse  and  worse.  He  sent  for 
the  doctor  a  second  time,  but  it  was  the  dispenser 
who  arrived  on  this  occasion  as  well.  The  elder 
died  towards  morning.  It  transpired  that  Dr. 
Petroff  had  been  dead  drunk  that  night.  The 
Zemstvo  immediately  dismissed  him  from  its  service. 
For  about  two  months  Petroff' s  name  did  not  leave 
the  columns  of  the  papers  and  became  notorious 
throughout  Russia. 

Six  months  later  I  encountered  Petroff  in  my 
house  ix\  St.  Petersburg;  he  had  arrived  to  seek  a 


290    THE  MEMOIRS  OF  A  PHYSICIAN 

place,  and  looked  me  up.  Sunburnt  and  uncoudi, 
in  a  starched  shirt  front,  to  which  he  was  unaccus- 
tomed, Petroff  sat  before  me  with  his  shaggy  head 
bowed  low  and  told  me  how  it  all  happened. 

"It  was  just  as  the  papers  described,  that's  true 
enough.  A  fair  was  being  held  at  the  time;  the 
out-patient  work  on  days  like  that  is  tremendous,  I 
had  to  attend  to  about  two  hundred  cases — you'll 
understand  what  that  means ;  while  the  night  before 
I  had  been  summoned  to  Stsheglovo  to  attend  a 
confinement,  and  returned  home  just  in  time  for  tak- 
ing over  my  out-patient  duty,  and  was  only  able  to 
swallow  a  glass  of  tea.  It  so  happened  that  a  few 
friends  visited  the  fair.  We  sat  down  to  cards  that 
evening  and  then  started  drinking.  It  can't  be  de- 
nied a  good  deal  was  drunk.  ... 

"Week  after  week,  month  after  month  pass  by 
in  the  self-same  way;  you're  pulled  to  pieces  from 
all  sides,  and  every  now  and  again  you  feel  so  down 
in  the  mouth  you'd  rather  die  than  go  on  at  the  same 
gait.  I  know  that  when  such  a  spell  overtakes  me 
— it  happens  five  or  six  times  in  the  year — I  have 
to  give  myself  a  shake  up,  have  a  good  drink,  so  as 
to  see  hell — ^and  after  that  you're  as  fresh  as  paint 
and  feel  braced  up  once  more.  .  .  .  Well,  I  got 
home.  And  I  was  called  to  a  patient — 'dying.' 
Sinner  that  I  am,  I  couldn't  go — the  hospital 
attendant  would  have  had  to  heave  me  on  to  the 
cart.  .  .  .  Well  .  ,  ,  and  so  it  happened."  .  .  . 


DOCTORS  AND  THE  LAW         291 

And  he  relapsed  into  silence. 

"You  don't  know,  old  man,  what  service  in  the 
Zemstvo  means.  You  have  to  be  on  good  terms  with 
every  one,  you  are  dependent  on  every  one.  Pa- 
tients come  whenever  they  please — during  the  day 
or  at  night:  how  turn  them  away?  Or  else,  some 
peasant  may  take  you  in  on  his  way  to  have  his 
horse  shod:  'Can't  vou  come  round,  a  woman  is 
dying  in  the  village?'  You  have  a  five  versts' 
drive  and  ask:  'Where's  the  patient?'  'Oh,  she's 
just  gone  off  to  reap  rye.'  .  .  .  My  district  is  fifty 
versts  ^  across,  with  a  dispensary  at  either  end,  and 
I  must  visit  each  twice  a  month;  the  devil  knows 
how  you  sleep  and  eat.  So  it  goes  on,  from  day  to 
day,  without  holidays,  without  a  break.  At  home 
your  son's  down  with  scarlet  fever,  while  off  you 
must  go.  ,  .  .  Extremely  hard  work."   .  .  . 

Once  more  he  relapsed  into  thought,  his  hands 
resting  on  his  knees. 

"Extremely  hard  work,"  he  repeated  and  pulled 
up.  "The  papers  wrote :  'Dr.  Petroff  was  drunk !' 
Quite  true,  I  was  drunk  and  that  was  very  wrong. 
Every  one  has  the  right  to  be  indignant.  But  they 
themselves — why,  ninety-nine  out  of  a  hundred  of 
them  aren't  averse  to  a  drink,  have  been  drunk  more 
than  once  and  don't  blame  themselves  for  it.  Only 
they  can't  understand  how  a  man,  who  isn't  given 
a  moment  of  his  life  to  call  his  own,  can  feel  some- 

J"-  A  verst  =  about  two-thirds  of  a  mile. — ^Translator. 


292     THE  MEMOIRS  OF  A  PHYSICIAN 

times.  .  .  .  And  oh,  how  hard  that  is,  old  man,  the 
Lord  preserve  one  from  such  a  fate." 

I  will  permit  myself  to  introduce  the  reader  to 
yet  another  newspaper  notice. 

"At  present  St.  Petersburg  may  be  called  'help- 
less,' "  wrote  in  July,  1898,  the  chronicler  of  the 
St.  Petersburg  Gazette,  V.  P.  "In  the  course  of  the 
last  week  I  thrice  had  occasion  to  convince  myself 
that  during  the  summer  the  inhabitants  of  the  me- 
tropolis are  entirely  deprived  of  medical  aid.  Dur- 
ing the  summer,  the  native  of  Petersburg  dares  not 
fall  ill,  otherwise  he  may  find  himself  in  an  awk- 
ward fix;  he  runs  the  risk  of  not  being  able  to  get  a 
doctor."  After  describing  how  he  and  some  of  his 
friends  searched  in  vain  throughout  St.  Petersburg 
for  a  medical  man,  Mr.  V.  P.  concludes  his  notice 
by  propounding  the  following  "very  interesting 
question  of  principle" :  "Have  physicians  the  right- 
to  neglect  their  duties  towards  their  patients  in  the 
way  they  do  at  present^  Are  doctors  absolutely 
free  agents  who  may  do  what  they  like  with  their 
time,  according  to  their  personal  inclinations?  In 
brief,  do  they  serve  society  or  not'?" 

These  questions  are  interesting,  forsooth.  .  .  . 
Do  doctors  serve  society  or  not?  Every  kind  of 
service  pre-supposes  at  least  some  sort  of  mutuality 
of  obligation.  Doctors  leave  St.  Petersburg  for  the 
summer;  some — to  rest  after  their  arduous  winter's 
work,  others — ^because  it  is  no  easy  matter  to  earn 


DOCTORS  AND  THE  LAW  293 

one's  living  by  practice  in  the  emptied  city.  They 
should  remain  in  town,  because  they  may  be  re- 
quired by  V.  P.  and  his  friends  and  because  they 
turn  up  their  noses  at  the  hospitals  (which  work 
during  the  summer)  and  at  the  municipal  physi- 
cians. Well,  and  supposing  V.  P.  and  his  friends 
remain  in  good  health — will  they  see  that  the  ex- 
penses of  the  doctors  remaining  in  town  on  their 
behalf  are  paid? 

Certainly  not !  Let  them  live  as  they  please,  but 
let  them  be  ever  ready  to  attend  at  any  moment  to 
the  needs  of  V.  P. ! 

The  value  of  this  notice  by  the  chronicler  of  the 
St.  Petersburg  Gazette  lies  in  the  naive  coarseness 
and  straightforwardness  with  which  it  gives  expres- 
sion to  the  views  predominating  amongst  the  public 
as  to  the  legitimacy  and  necessity  of  reducing  the 
faculty  to  a  state  of  serfdom. 

"Are  doctors  absolutely  free  agents  who  may  do 
what  they  like  with  their  time,  according  to  their 
personal  inclinations?"  The  question  does  not  re- 
fer to  physicians  holding  special  fixed  appointments, 
who,  by  accepting  the  advantages  of  an  assured 
position  which  their  appointments  offer  them, 
thereby  naturally  relinquish  their  "absolute  free- 
*  dom" ;  it  refers  to  the  faculty  at  large,  in  its  dealing 
with  persons  who  do  not  consider  themselves  bound 
down  by  any  corresponding  obligations  whatever. 
They  follow  the  physician's  every  step  with  terrible, 


294     THE  MEMOIRS  OF  A  PHYSICIAN 

unflinching  and  merciless  vigilance:  "Serve  soci- 
ety, be  a  hero  and  a  champion,  never  dare  avail 
yourself  of  the  'incomprehensible  custom'  of  resting; 
and  when  you  are  worn  out  or  when  you  perish  in 
harness,  it  is  no  business  of  ours."  ^ 

A  short  time  ago  we  buried  our  comrade  Dr. 
Stratonoff.  A  week  previously  he  had  performed 
tracheotomy  in  a  private  house,  and  while  sucking 
the  diphtherial  membrane  out  of  the  incision  in  the 
windpipe,  contracted  diphtheria  himself.  He  died 
while  young,  strong  and  energetic,  and  his  death 
was  terrible  in  its  rapidity  and  unexpectedness. 

His  coffin  stood  in  the  chapel,  covered  with  un- 
necessary wreaths.  The  air  was  pervaded  with  the 
fragrance  of  incense,  the  last  notes  of  the  "Eternal 
Memory"  died  away  beneath  the  vaulted  roof,  while 
the  rush  and  roar  of  the  city  was  wafted  in  through 
the  windows.     We  stood  round  the  bier — 

2  During  session  of  the  Assembly  of  the  Zemstvo  of  St.  Peters- 
burg, the  executive  of  that  administrative  body  proposed  that  a  sub- 
sidy be  granted  to  two  medical  health  officers  and  a  dispenser, 
who  had  contracted  typhoid  while  in  performance  of  their  duties. 
Member  P.  P.  Durnovo  violently  opposed  this  motion.  No  one,  he 
declared,  was  insured  against  infection,  while  doctors,  in  view  of 
the  very  character  of  their  work,  were  in  duty  bound  to  run  such 
risks  to  their  healths.  If  a  doctor  died  one  might  grant  his  family 
assistance,  but  in  the  present  case  he  had  merely  been  taken  ill. 
Of  the  nine  medical  health  officers  of  the  province,  at  least 
one  would  be  down  with  typhoid,  or  some  other  disease,  every  year; 
was  it  possible  that  in  every  such  instance  the  Zemstvo  ought  to  hold 
itself  bound  to  provide  pecuniary  assistance?  //  the  Zemstvo  <vjere 
to  distribute  grants  so  lavishly,  doctors  ivould  contract  typhoid  on 
purpose.  To  the  credit  of  the  St.  Petersburg  Zemstvo  Mr.  Dur- 
novo's  declarations  elicited  the  unanimous  protest  pf  the  Assembly. 


DOCTORS  AND  THE  LAW   ,      295 

"And  silently  gazed  on  the  face  of  the  dead, 
Immersed  in  sad  thought  of  the  morrow."  .  .  . 

He  left  a  widow  and  orphans :  but  neither  his  fate 
nor  theirs  was  any  one's  concern.  All  indifferent, 
the  city  beyond  the  windows  of  the  chapel  kept  up 
its  noisy  bustle;  one  might  have  thought  that  even 
were  all  its  streets  strewn  with  dead  bodies,  it  would 
continue  to  lead  the  same  self-centred  busy  life, 
without  distinguishing  corpse  from  cobble-stone.  .  .  . 

''Do  our  doctors  serve  society  or  not'?'"' 

According  to  Dr.  Grebenshtshikoff's  calculations, 
37  per  cent,  of  our  doctors  in  general  die  of  infec- 
tious diseases,  the  latter  accounting  for  sixty  per 
cent,  of  the  deaths  occurring  amongst  physicians 
serving  in  the  Zemstvos. 

In  1892,  half  of  all  the  Zemstvo  doctors  who 
died  that  year  succumbed  to  typhoid.  Professor 
Sikorsky  investigated  the  question  of  suicide  in  the 
Russian  medical  fraternity,  availing  himself  of  of- 
ficial data.  He  found  that  "within  the  age  limits 
of  25-35  years  suicide  accounted  for  almost  10  per 
cent,  of  the  normal  death-rate,  i.e.  at  this  age, 
amongst  doctors^  one  death  out  of  every  ten  was 
self-inflicted'^  This  number  is  so  appalling  that 
we  can  hardly  credit  it.  But  another  investigator. 
Dr.  Grebenshtshikoff,  arrived  at  almost  the  same 
results,  although  utilising  entirely  different  mate- 
rial and  working  independently  of  Professor  Si- 
korsky.    According  to  his  statistics,  during  1889- 


296     THE  MEMOIRS  OF  A  PHYSICIAN 

1892,  amongst  all  doctors,  suicide  accounted  for  3.4 
per  cent,  of  their  deaths,  while  over  ten  per  cent,  of 
all  the  Zemstvo  doctors  died  by  their  own  hand. 

Professor  Sikorsky  then  proceeds  to  compare  his 
data  with  those  dealing  with  the  other  professions, 
both  in  Russia  and  Western  Europe.  It  turned  out 
that  in  the  matter  of  suicide  the  Russian  faculty 
'''enjoyed  the  sad  distinction  of  occupying  the  first 
place  in  the  "xorldT 

The  following  circumstance  is  most  remarkable: 
one  might  be  led  to  suppose  that  no  one,  bent  on 
self-destruction,  would  find  it  so  easy  to  choose  a 
painless  mode  of  death  as  a  doctor.  But  in  reality 
it  turns  out  that  in  the  case  of  medical  men  the 
more  agonising  methods  of  self -despatch  figure  most 
frequently:  poisoning  by  strychnine,  sulphuric  or 
carbolic  acid,  piercing  of  the  heart  with  a  trocar,  etc. 
''Evidently,"  remarks  Professor  Sikorsky,  "a  con- 
siderable deadening  of  the  instinct  of  self-preserva- 
tion made  the  mode  of  death  a  matter  of  indifference 
to  these  unhappy  colleagues  of  ours,  so  long  as  they 
attained  their  end." 

Yes,  our  doctors  "serve  society,"  and  their  servi- 
tude is  not  of  the  lightest  or  most  serene  order. 
And  this  is  the  fate  which  awaits  those  doctors  who 
have  "completed  their  term  of  service  to  society." 
In  Russia  we  have  a  medical  subsidiary  fund,  in- 
augurated by  Professor  J.  A.  Tshistovitch.  Before 
me  lie  the  printed  minutes  of  the  sittings  of  the 


DOCTORS  AND  THE  LAW         297 

executive  committee  of  the  Society  for  1896.  I 
adduce  two  extracts  from  the  above. 

"The  petition  of  one  of  the  members  of  the  fund, 
M.  A.  Vissotsky,  in  which  he  requested  that  a  pen- 
sion be  awarded  him  in  view  of  his  entire  destitution 
and  incapacity  to  continue  in  practice,  owing  to  ill- 
health,  was  reported  upon.  Mr.  Vissotsky,  aged 
59,  is  a  former  municipal  physician  of  Ashin,  has 
no  means,  receives  no  Government  pension,  has  no 
relatives  who  could  give  him  a  home,  is  incapable 
of  gaining  his  livelihood  by  work,  and  stands  in 
need  of  nursing,  owing  to  his  suffering  from  ad- 
vanced heart  disease  and  paralysis  of  the  left  side. 
A  pension  of  300  roubles  (about  $150)  awarded. 

"The  petition  of  the  female  physician  K.  F. 
Lantveroff,  soliciting  the  grant  of  a  subsidy  of  200 
roubles,  in  view  of  her  very  straightened  pecuniary 
situation,  due  to  her  suffering  from  chronic  malaria 
and  extreme  ansemia,  developed  after  an  attack  of 
typhus  contracted  in  the  service  of  the  Zemstvo, 
reported  upon.  Professor  V.  A.  Manassein  and  Dr. 
D.  N.  Jbankoff  certified  Mme.  Lantveroff 's  dis- 
tressed situation,  and  the  necessity  of  her  being 
provided  with  the  means  to  pay  for  her  medical 
treatment,  board  and  lodging.  Two  hundred  rou- 
bles granted." 

The  above  fund  is  one  of  mutual  assistance  and 
is  sustained  by  the  annual  subscriptions  of  its  mem- 
bers,   who    alone   have    a   claim    upon   its    assist- 


/ 


298    THE  MEMOIRS  OF  A  PHYSICIAN 

ance.  Of  course  society,  which  doctors  serve,  has 
nothing  to  do  with  this  fund,  nor  does  it  desire  to. 
"You  may  fall  victims  to  infection,  you  may  cripple 
yourselves  in  working  for  us,  but  once  fallen  in  the 
ranks,  you  may  help  yourselves  as  best  you  can." 
The  dimensions  of  the  grants  allowed  speak  for 
themselves,  and  show  what  aid  the  fund  is  capable 
of  according  its  members. 


CHAPTER  XX 

THE    MARKET    FOR   DOCTORS 

AMONGST  others,  the  following  thesis  figures 
iPx  V.  K.  Anrep's  doctor's  dissertation :  "The 
petty  police  officers,  dvorniks  ^  and  janitors  of  St. 
Petersburg  are  better  paid  than  the  physicians  in  its 
service."  This  statement  is  not  in  the  least  exag- 
gerated. The  house-physicians  in  the  hospitals  of 
many  of  our  towns  receive  45-50  roubles  a  month; 
only  quite  recently  those  of  St.  Petersburg  had  their 
salaries  advanced  to  75  roubles.  Our  municipal 
doctors,  while  burdened  with  a  mass  of  the  most 
varied  duties,  only  receive  200  roubles  (roughly 
$100)  a  year.  According  to  a  census  made  by 
Grebenshtshikoff,  16  per  cent,  of  our  doctors  en- 
dowed with  fixed  appointments  receive  less  than 
600  roubles  a  year,  62  per  cent,  no  more  than  1200 
roubles. 

The  opinion  is  very  prevalent  that  salaried  doc- 
tors can  easily  eke  out  their  miserable  stipends  by 
private  practice,  and  this  furnishes  an  explanation 
as  to  the  reason  why  these  appointments  are  so  badly 
paid.     But  the  first  condition  necessary  for  private 

1  Dvornik  =  house  porter. — ^Translator. 


300    THE  MEMOIRS  OF  A  PHYSICIAN 

practice  is  the  free  disposal  of  one's  time ;  this,  how- 
ever, must  necessarily  unfavourably  affect  the  nor- 
mal discharge  of  one's  official  duties,  and  woe  to 
the  doctor  who  displays  negligence  in  his  capacity 
of  a  paid  Servant  of  Society:  he  becomes  the  object 
of  universal  obloquy,  people  forgetting  that  they 
themselves  designated  private  practice  as  a  sub- 
sidiary source  of  income.  Also  the  latter  is  very 
small — contrary  to  prevailing  opinion:  according  to 
the  researches  of  the  statistician  just  quoted,  in  the 
case  of  7/  per  cent,  of  all  (Russian)  doctors  (in- 
cluding those  without  official  status),  the  income 
derived  from  private  practice  does  not  exceed  1000 
roubles  'per  annum.  Few  of  the  liberal  professions 
can  boast  worse  remuneration. 

Our  medical  market  has  long  been  glutted,  the 
supply  considerably  exceeding  the  demand.  This 
leads  to  competition  amongst  doctors,  the  least  esti- 
mable members  of  the  faculty  stopping  before  no 
means  for  depriving  a  rival  of  a  patient;  when 
asked  to  call,  such  doctors  commence  by  criticising 
their  predecessor's  prescriptions,  declaring  "that  it 
wouldn't  take  long  to  kill  the  patient  that  way." 
The  advertising  columns  of  our  newspapers  are 
covered  with  such  men's  advertisements,  their  names 
becoming  as  well  known  as  those  of  certain  soap  and 
cocoa  manufacturers.  The  more  adroit  push  them- 
selves before  the  notice  of  the  public  through  news- 
paper articles  and  interviews  with  accounts  of  the 


THE  MARKET  FOR  DOCTORS      301 

brilliant  operations  performed  by  them,  cures  ob- 
tained, etc.  On  the  other  hand,  not  a  few  doctors, 
having  assured  themselves  of  the  difficulties  lying  in 
their  way  and  the  precariousness  of  their  profession, 
take  up  some  other  occupation;  the  number  of  the 
latter  seems  to  be  ever  increasing.  During  recent 
years,  accounts  have  appeared  in  the  newspapers 
from  time  to  time,  describing  how  doctors  commit- 
ted suicide  owing  to  their  being  in  absolute  desti- 
tution; instances  are  known  of  fully  qualified 
medical  men  accepting  situations  as  dispensers  and 
hospital  orderlies,  contenting  themselves  with  the 
wages  of  these  humble  positions. 

Even  people  of  comparative  education  sometimes 
express  the  opinion  that  the  reason  why  so  many 
doctors  find  themselves  in  a  distressed  position  lies 
in  their  gravitation  towards  cities.  These  persons 
will  say:  "We  have  about  twenty  thousand  doc- 
tors, while  the  population  of  Russia  is  128,000,000. 
How  can  there  be  a  question  of  over-production  *? 
Doctors  dislike  going  to  out-of-the-way  parts  of  the 
country,  and  insist  upon  dwelling  in  centres  of  cul- 
ture ;  obviously  a  glut  in  the  market  of  those  centres 
must  result  I  But  the  above  phenomenon  is  purely 
artificial:  doctors  starve  in  these  centres,  while  the 
rural  population  perishes  and  degenerates  without 
knowing  medical  succour.  We  have  too  few  medi- 
cal men,  not  too  many  of  them,  and  every  effort 
should  be  made  to  increase  their  numbers." 


302     THE  MEMOIRS  OF  A  PHYSICIAN 

It  is  quite  true  that  the  rural  population  is  perish- 
ing and  degenerating  without  medical  succour. 
But  is  it  possible  that  the  reason  thereof  lies  in  a 
dearth  of  medical  men*?  Half  the  population  of 
Russia  goes  about  shod  in  bark  shoes — is  it  possible 
that  this  is  because  we  lack  cobblers'?  You  may 
increase  the  numbers  of  cobblers  ad  infinitum,  with 
the  only  result  that  the  cobblers  will  be  reduced  to 
wearing  bark  shoes  themselves,  while  all  those  who 
wore  them  formerly  will  continue  to  do  so. 

Doctors  are  far  from  being  possessed  of  such  a 
strange  taste  as  to  prefer  starvation  in  cities  to  bread 
in  the  back-blocks.  There  are  always  shoals  of  ap- 
plicants for  the  most  out-of-the-way  situations  of 
the  Zemstvos,  with  the  most  pitiful  pay:  for  in- 
stance, in  1883  (see  The  Fhysician),  seventy-six 
applications  were  filed  for  one  vacancy  of  2^mstvo 
physician  in  the  Kniaguinensky  district;  while  an- 
other, in  the  district  of  Kashin,  was  competed  for 
by  ninety-two  medical  men.  The  crux  of  the  mat- 
ter does  not  lie  in  the  physician's  horror  of  burying 
himself  in  some  remote  rural  district,  but  in  the  fact 
that  our  village  is  hopelessly  poor  and  incapable  of 
paying  a  doctor  for  his  ministrations.  The  late 
eighties  give  us  not  a  few  examples  of  experiments 
of  free  practice  in  the  country;  the  names  of  Sitshu- 
goff  and  Tairoff  and  others  will  still  be  fresh  in  the 
memory  of  all.  But  these  experiments  merely 
proved  that  men,  inspired  by  an  idea,  can  manage 


THE  MARKET  FOR  DOCTORS      303 

to  eke  out  a  livelihood  somehow,  even  in  the  coun- 
try, without  extraneous  assistance.  However,  that 
is  not  the  question  at  all;  the  question  is,  can  an 
average  medical  man,  not  a  knight-errant,  but  an 
ordinary  worker,  exist  in  the  country,  relying  on  his 
profession  alone?  Any  one  who  is  but  slightly  ac- 
quainted with  the  conditions  of  our  rural  life  will 
agree  that  its  poverty  and  lack  of  culture  entirely 
shut  off  the  ordinary  practitioner. 

The  material  position  of  doctors  is  ever  becoming 
worse.  And  now  woman  enters  the  lists  as  a  new 
rival — ^much  desired,  and  at  the  same  time  most 
formidable.  As  everywhere,  where  she  enters  into 
competition  with  man — being  satisfied  with  less  pay 
for  the  same  amount  of  work — she  lowers  the  aver- 
age level  of  prosperity.  Data  furnished  by  Dr. 
Grebenshtshikoff  show  that  the  mean  salary  (in  Rus- 
sia) of  male  doctors  in  the  public  service  amounts 
to  1161  roubles,  while  that  of  the  female  physician 
is  only  833  roubles.  With  the  increase  of  the 
number  of  medically  qualified  women,  there  can  be 
no  doubt  that  the  average  earnings  of  the  doctors 
will  ever  become  less. 

Such  a  state  of  affairs  does  not  subsist  in  Russia 
alone.  In  Western  Europe  the  physician's  plight  is 
still  more  distressed.  Everywhere  we  see  a  vast 
army  of  medical  men  without  work  and  without 
money,  ready  to  accept  anything.  Eight  years  ago 
the  Hospital  Fund  of  Budapest  made  known  that 


304    THE  MEMOIRS  OF  A  PHYSICIAN 

it  would  pay  its  doctors  forty  kreuzers  (about  12 
cents)  for  each  visit  to  a  patient;  notwithstanding 
the  scantiness  of  the  pay,  shoals  of  applicants,  eager 
to  accept  these  terms,  put  in  an  appearance.  More 
than  half  of  the  doctors  residing  in  Berlin  barely 
earn  150  marks  {circa  $37)  a  month;  the  doctors 
of  Vienna  do  not  turn  their  nose  up  at  twenty 
kreuzers  fees.  Henri  Beranget,  in  an  article  on  the 
"Intellectual  Proletariat  of  France,"  says  that  no 
less  than  half  of  the  Parisian  doctors  cannot  even 
claim  to  be  in  circumstances  placing  them  beyond 
the  pinch  of  want;  while  the  majority  of  that  half 
are  in  an  abject  condition  of  destitution,  in  the  full- 
est sense  of  the  word,  many  members  of  the  profes- 
sion frequently  seeking  the  shelter  of  doss-houses 
for  the  night.  In  the  provinces  barely  five  thousand 
out  of  ten  earn  a  decent  livelihood. 

In  Western  Europe  innumerable  doctors  are  un- 
able to  find  anything  to  do,  but  of  course  the  reason 
does  not  lie  in  society's  being  sufficiently  provided 
with  medical  aid  already — for  there,  as  in  Russia,  for 
the  vast  majority  of  the  population,  the  ministrations 
of  medicine  are  still  an  unattainable  luxury.  This 
is  but  a  partial  manifestation  of  those  amazing 
incongruencies  which,  like  the  roots  of  an  oak  im- 
bedded in  the  soil,  deeply  penetrate  into  the  very 
foundations  of  modern  existence.  Countless  tons 
of  grain  and  meat  rot  without  finding  a  market, 
while  next  door,  thousands  of  human  beings  die  of 


THE  MARKET  FOR  DOCTORS      305 

starvation  for  want  of  work;  blood  is  lavishly  ex- 
pended in  the  conquest  of  far-away  markets  for  dis- 
posing of  our  silks  and  velvets,  while  the  people 
employed  in  their  production  go  about  in  cotton 
rags. 


CHAPTER  XXI 

THE    doctor's    struggle 

THE  other  day  I  was  called  at  an  early  hour  to 
see  a  patient  in  one  of  the  suburbs  of  St. 
Petersburg. 

That  night  sleep  had  long  eluded  me,  for  I  was 
suffused  by  a  strange  sensation :  my  head  was  heavy 
and  dull,  something  in  my  breast  vibrated  tremu- 
lously and  I  felt  as  if  all  my  nerves  were  the  taut 
strings  of  some  instrument;  the  distant  reverbera- 
tion of  a  locomotive  whistle  at  the  railway  station, 
the  cracking  of  the  wall  paper,  made  me  start  pain- 
fully with  fluttering  heart.  After  taking  some 
potassium  bromide  I  at  last  dozed  off,  only  to  be 
roused  an  hour  later. 

It  was  barely  light.  I  took  a  cab  and  rumbled 
off  through  the  dark,  empty  streets.  Through  the 
light  mist  heralding  the  dawn,  sullenly  vibrated  the 
"buzzers"  of  various  works  and  factories;  it  was 
both  cold  and  damp;  here  and  there  lights  winked 
sleepily  in  the  windows.  I  experienced  a  vague 
feeling  of  void,  and  apprehension  crept  into  my 
heart.  Recalling  my  condition  of  the  previous 
evening  and  noting  my  present  broken-down  state, 
it  was  borne  upon  me  with  horror  that  I  was  ill, 

30^ 


THE  DOCTOR'S  STRUGGLE        307 

seriously,  unmistakably  ill!  For  the  last  twenty- 
four  months  I  had  noticed  that  my  nerves  were  ever 
becoming  more  and  more  unstrung,  but  only  now 
did  I  plainly  see  what  I  had  come  to. 

I  had  been  a  doctor  for  seven  years.  How  had  I 
lived  them^  They  had  been  a  cruel  mockery  from 
beginning  to  end;  my  impotence  ever  flaunted  in 
my  face,  the  tension  on  my  nerves  never  being  re- 
laxed for  a  moment,  merciless  life  ceaselessly  play- 
ing its  harsh  tunes  upon  them.  To  pass  through 
the  ordeal  unscathed,  an  iron  constitution  and  tre- 
mendous nervous  energy  were  necessary,  the  con- 
ditions of  life  being  such  as  to  undermine  the  most 
robust.  I  knew  no  such  things  as  holidays,  and 
could  never  be  sure  of  enjoying  undisturbed  rest;  I 
might  be  called  away  at  any  moment  from  my  meals 
or  from  my  sleep,  and  kept  from  home  for  hours, 
no  one  giving  my  powers  of  endurance  a  thought. 
Year  by  year  one  becomes  more  and  more  of  a 
physical  wreck  and  a  neurasthenic  creature,  every- 
thing going  by  the  board — joy  and  love  of  life — 
worse — the  very  capacity  for  sympathy  and  warm 
responsiveness.  And  at  the  same  time  I  knew  very 
well  that  these  nobler  qualities  were  not  entirely 
dead — a  short  spell  of  life  in  normal  human  en- 
vironment sufficed  to  regenerate  the  soul  and  one 
felt  that  it  was  still  very  full  of  latent  strength  and 
love. 

How  did  I  live?     After  waiting  for  five  years  I 


3o8    THE  MEMOIRS  OF  A  PHYSICIAN 

had  at  last  obtained  an  appointment  worth  seventy- 
five  roubles  a  month ;  this,  plus  the  uncertain  income 
derived  from  private  practice,  had  to  support  me 
and  my  wife  with  our  two  children.  Such  questions 
as  that  of  buying  a  new  winter  overcoat,  the  pur- 
chase of  fuel  or  the  hire  of  a  nurse,  were  knotty 
problems  which  entailed  a  lot  of  painful  mental 
labour  and  sometimes  necessitated  visits  to  the  pawn- 
broker's. 

My  school-fellows  had  chosen  various  paths  in 
life — some  were  engineers,  others  tax  collectors  or 
excise  officials,  business  men,  etc.;  for  work  which 
allowed  of  their  leading  a  tranquil  and  undisturbed 
existence  they  received  salaries  that  were  beyond 
my  dreams.  I  was  even  deprived  of  domestic  joys, 
forbidden  the  pleasure  of  carelessly  caressing  my 
children,  because  I  could  not  thrust  away  the  thought 
that  perhaps  I  might  be  giving  them  scarlet  fever 
or  the  smallpox,  etc.,  with  which  I  came  into  daily 
contact. 

The  great  city,  enveloped  in  morning  fog,  passed 
in  review  before  me:  high  buildings,  sombre  and 
silent,  jostled  each  other,  appearing  to  be  immersed 
in  cheerless  reverie.  Here  was  that  Moloch  that 
claimed  all  my  strength,  health,  and  my  very  life! 
At  the  same  time  the  consciousness  of  that  terrible 
monster's  utter  obliviousness  of  my  individuality 
was  appalling.  .  .  .  And  I  was  powerless  to  do 
otherwise  than  bow  my  head  before  it — that  city 


THE  DOCTOR'S  STRUGGLE        309 

which  took  away  my  all  and  gave  me  nothing  in 
return. 

Absurd  delusion  to  imagine  that  it  were  possible 
for  me  to  excite  its  pity;  equally  ridiculous  to  ex- 
pect that  anything  could  be  gained  by  drawing  at- 
tention to  the  unjust  treatment  meted  out  to  our- 
selves. Only  he  who  fights  can  claim  a  hearing. 
The  only  thing  remaining  is  for  us  doctors  to  band 
together  and  fight  this  monster  with  united  forces 
shoulder  to  shoulder,  and  by  strength  of  arms  carve 
for  ourselves  a  happier  and  freer  destiny. 

While  turning  these  matters  over  in  my  mind  I 
had  not  noticed  how  we  had  left  the  main  thorough- 
fares and  were  now  driving  along  a  suburban  road. 
The  roadside  ditches  were  overgrown  with  coarse 
yellow  grass,  and  a  wooden  sidewalk,  wet  with  dew, 
stretched  away  on  either  side  in  monotonous  per- 
spective. Dense  black  smoke  welled  out  of  the  fac- 
tory chimneys  and  spread  itself  in  a  dark,  suffocating 
mantle  above  the  housetops.  My  Jehu  pulled  up  in 
front  of  an  ugly,  yellowish-brown  tenement  house. 

I  ascended  to  the  second  floor  by  some  dark  and 
steep  stairs,  and  rang.  In  a  small  room  a  pale  man 
of  about  thirty,  dressed  in  a  blue  blouse,  sat  at  a 
table ;  his  blond  beard  and  moustache  were  blotched 
with  red,  while  on  the  floor  next  him  stood  an  earth- 
enware basin  full  of  pinkish  water,  in  which  floated 
dark  clots  of  blood.  A  young  woman,  bathed  in 
tears,  was  breaking  ice  with  a  chopper. 


310    THE  MEMOIRS  OF  A  PHYSICIAN 

"Please  excuse  me,  Doctor,  for  bothering  you!" 
said  the  man,  rapidly  rising  and  stretching  out  his 
hand.  "It's  the  usual  thing — consumption — and 
I've  just  had  a  hsemorrhage.  It  was  my  wife  who 
insisted  on  sending  for  a  doctor."  .  .  . 

I  cut  him  short. 

"First  of  all  lie  down  and  don't  talk!  You 
shouldn't  say  a  word.  And  don't  be  excited,  it 
isn't  at  all  dangerous." 

"Am  I  excited"?"  he  asked  in  surprise,  and  with 
a  shrug  of  his  shoulders,  sat  himself  down  on  the 
bed. 

I  had  him  undressed  and  carefully  applied  my 
stethoscope  to  his  chest.  With  his  handsome  head 
thrown  back  and  biting  his  thin  ensanguined  lips,  he 
lay  still  with  half-closed  eyes,  gazing  up  at  the  ceil- 
ing. 

"What  is  your  husband's  profession*?"  I  asked  the 
young  woman,  on  completing  my  examination. 
She  was  sitting  at  the  table  with  wet  cheeks,  follow- 
ing my  movements  sorrowfully. 

"He's   a   copper   foundryman   employed   in   the 

works.     Oh,   Lord,   Lord,   to  think  that  he 

should  only  have  lasted  till  he  was  thirty !  He  used 
to  be  so  strong !  .  .  .  The  copper  fumes  have  eaten 
out  his  chest !" 

And  she  leaned  her  breast  against  the  table  con- 
vulsed with  sobs. 

"Don't  take  on  so,  Kitty!     It's  not  so  bad  as  all 


THE  DOCTOR'S  STRUGGLE        311 

thatj"  the  foundryman  murmured  impatiently  and 
at  the  same  time  kindly.  "You  heard  what  the  doc- 
tor said.  .  .  .  People  live  to  be  fifty  with  such 
haemorrhages.  .  .  .  Isn't  it  so*?"  he  asked,  turning 
to  me. 

''Yes,  of  course  I  ,  .  ,  Only  don't  talk,  but  lie 
still.     Sometimes  people  quite  get  over  it." 

He  lay  quiet,  merely  nodding  his  approval.  I 
sat  down  to  write  a  prescription. 

"My  God,  how  soon  his  life  broke  him  down!" 
the  woman  went  on  with  a  shivering  sigh.  "I  will 
tell  you  how  it  is,  sir,  he  doesn't  take  a  bit  of  care 
of  himself;  you  should  hear  what  a  life  he  led  I 
On  coming  home  from  work  he'd  take  up  his  books 
at  once,  or  else  be  hurrying  about  on  business.  .  .  . 
He  wasn't  given  the  strength  of  two  men  I" 

The  patient  was  seized  with  a  fit  of  coughing, 
bent  forward  and  spat  out  a  large  clot  of  blood. 

'That'll  do  I  Don't  talk  so  much  I"  he  said  to 
his  wife  in  an  undertone,  on  regaining  his  breath. 

I  remained  for  about  half  an  hour  with  the  pa- 
tient, trying  to  console  and  calm  his  wife.  The 
room  was  a  poor  one,  but  all  testified  to  its  owner's 
tastes.  A  heap  of  books  were  piled  in  a  corner, 
books  were  strewn  over  the  chest  of  drawers  and 
lay  upon  the  sewing-machine,  and  their  covers  bore 
names  that  were  dear  and  precious  to  me. 

I  went  out  and  drove  off.  It  was  quite  light  by 
now ;  the  mist  had  lifted  from  the  ground  and  was 


312     THE  MEMOIRS  OF  A  PHYSICIAN 

ascending  heavenwards  in  moist,  grey  clouds;  be- 
tween their  rifts  one  caught  glimpses  of  a  clear, 
sunny  sky.  The  streets  still  retained  their  still- 
ness, but  already  smoke  issued  from  the  chimney- 
pots and  people  could  be  seen  in  the  windows;  the 
footprints  of  early  pedestrians  marked  the  dewy 
wooden  footpath.  I  recalled  the  humour  in  which 
I  had  started  out  from  home  and  gazed  upon  the 
selfsame  surroundings — that  coarse  yellow  grass 
about  the  roadside  ditches,  the  tall  houses — and 
was  struck  by  its  exceeding  triviality — it  seemed 
entirely  foreign  to  me;  not  that  I  felt  ashamed — 
merely  I  was  unable  to  account  for  having  let  my- 
self go  in  such  a  way. 

We  must  combine  and  fight  the  good  fight — quite 
so!  But  who  are  'We""?  We  doctors?  Of 
course  we  may  try  to  better  the  position  of  our  cor- 
poration, perfect  co-operation  and  the  like.  But  a 
struggle,  a  struggle  all-embracing  and  deep-reach- 
ing, is  impossible  if  the  emblem  on  our  standard  be 
a  brass  farthing.  Our  lot  is  a  hard  one,  but  how 
immeasurably  more  wretched  is  that  of  a  vast  num- 
ber of  our  humbler  brethren!  In  some  parts  of 
Russia  the  workmen  employed  in  the  matting  indus- 
try are  hired  on  condition  of  their  not  begging  in 
the  public  streets;  it  is  quite  common  for  girls  to 
prostitute  themselves  to  the  foremen  in  order  to  get 
work  to  do.  .  .  . 

No  doubt  it  would  be  very  nice  if  we  doctors 


THE  DOCTOR'S  STRUGGLE        313 

received  the  same  emoluments  as  engineers,  if  we 
could  work  without  overtaxing  our  strength  and 
without  thought  for  the  morrow.  But  easier  said 
than  done.  A  physician  in  the  employ  of  the 
Zemstvo  receives  beggar's  pay,  but  the  village  can- 
not create  meat  and  wine  for  him  out  of  its  own 
crust  of  black  bread. 

The  remuneration  of  the  physician  is  very  low 
as  a  rule,  nevertheless,  not  only  for  the  poor  man, 
even  for  the  person  of  average  means,  medical  treat- 
ment is  ruinous.  All  this  tends  to  show  that  an- 
other way  out  of  the  labyrinth  must  be  found. 
Ours  should  not  be  the  fight  of  a  legion  forming 
an  integral  part  of  a  great  army,  but,  rather,  that 
of  a  handful  of  individuals  whose  efforts  are  directed 
against  all  who  surround  them,  and  are,  for  that 
reason,  senseless  and  condemned  to  failure.  Oh, 
why  should  this  truth  be  so  difficult  for  us  to  under- 
stand, for  us  who  have  been  nurtured  on  noble  ideas, 
before  whom  education  has  unfolded  "broad  hori- 
zons"; while  those  who  have  been  placed  at  a  dis- 
advantage from  birth  and  were  compelled  to  conquer 
every  foot  of  their  ground,  have  long  ago  grasped 
the  fact? 

Yes,  there  is  another  way.  That  only  way  lies  in 
the  realisation  that  we  are  but  a  small  part  of  one 
gigantic  integral  whole,  that  our  own  brighter  future 
is  indissolubly  bound  up  with  the  advancement  and 
prosperity  of  that  great  whole  in  its  entirety. 


APPENDIX  A 

(Editor's  Notes  to  the  Foregoing  Chapters) 

Chapter  I 

THE    FRAILTY    OF    THE    HUMAN    BODY 

In  this  chapter  the  author  has  touched  on  experi- 
ences that  are  well  known  to  every  medical  student. 
The  years  in  the  medical  school  are  devoted  to  the 
study  of  cases  that  are  unusual  and  are  sent  to  the 
medical  school  hospitals  for  treatment  that  they  can- 
not get  at  home.  As  a  consequence  the  student  be- 
comes more  familiar  with  them  than  he  does  with 
the  more  common  disorders  and  he  is  apt  to  view 
every  case  during  the  first  year  or  two  of  his  practice 
as  probably  being  some  rare  disorder.  It  would  be 
of  great  value  if  a  three  months'  apprenticeship  with 
a  practitioner  could  be  incorporated  into  the  curricu- 
lum of  our  medical  schools. 

Chapter  II 

EXAMINATION    AND    AUTOPSY 

The  problem  of  whether  or  not  to  allow  students 
to  examine  patients  admitted  to  the  charity  wards 
of  the  large  hospitals  is  a  very  complex  one.  That 
it  is  necessary  in  the  education  of  the  student  to  ob- 

314 


EDITOR'S  NOTES  315 

serve  patients  closely  is  beyond  question;  that  the 
recovery  of  such  patients  is  at  times  hampered  by 
such  examination  is  in  many  cases  perfectly  true. 
If  such  examinations  are  conducted  tactfully  and 
carefully  the  mental  strain  is  lessened.  It  resolves 
itself,  therefore,  into  a  matter  of  great  care  and 
judgment  on  the  part  of  the  professors  in  the  medi- 
cal schools  to  teach  the  students  how  to  make  such 
examinations  without  causing  distress  to  the  patient. 
In  a  vast  majority  of  cases  a  thorough,  serious  and 
minute  examxination  by  the  students  is  welcomed 
by  even  the  most  ignorant  patients.  Personal  at- 
tention and  sincere  interest  is  always  appreciated 
and  the  examinations  become  agreeable  rather  than 
unpleasant.  In  the  present  day  the  clinical  work 
done  by  the  student  himself  on  the  case  under  his 
observation  yields,  in  many  instances,  a  wealth  of 
information  that  is  of  material  assistance  in  secur- 
ing a  satisfactory  diagnosis  of  the  case.  It  is  be- 
coming more  and  more  unusual  in  America  to  have 
patients  raise  much  objection  to  going  to  a  medical 
school  hospital  on  account  of  being  subjected  to 
examination  by  students.  It  is  still  rarer  to  find 
after  their  return  that  they  have  anything  but  praise 
for  the  careful  work  that  has  been  done.  The 
whole  matter  resolves  itself  into  a  question  of  tact- 
ful management  and  sincere  interest  on  the  part  of 
both  teacher  and  student.  When  this  is  secured  the 
questiQii  of  examination  is  negligible.     In  the  per- 


3i6     THE  MEMOIRS  OF  A  PHYSICIAN 

formance  of  autopsies  on  the  bodies  of  patients,  a 
much  greater  problem  presents  itself,  but  in  such 
matters  also  the  exercise  of  tact  and  consideration 
carries  great  weight.  There  are  certain  hospitals 
which  require  permission  for  an  autopsy  in  the  event 
of  a  patient's  death  to  be  signed  by  relatives  before 
the  patient  is  admitted  to  the  wards.  In  most  other 
hospitals,  however,  permission  is  only  obtained  from 
the  relatives  after  death  and  it  is  surprising  how 
seldom  objection  is  raised.  The  request  is  presented 
tactfully  and  the  family  are  made  to  realise  that  the 
life  of  some  other  sufferer  may  be  saved  by  the 
knowledge  derived  from  the  autopsy.  Regarding 
the  examination  of  patients — particularly  female 
patients  in  clinics — the  problem  is  distinctly  more 
complex.  Such  examinations  cannot  be  ignored 
and  their  importance,  particularly  in  the  case  of  the 
most  sensitive  individuals,  can  hardly  be  over- 
estimated. Extremely  frequently  patients  are  sent 
to  university  hospitals  by  the  physicians  in  their 
own  towns  because  these  physicians  have  been  unable 
to  make  the  necessary  examinations.  Often  it  is 
discovered  in  the  course  of  a  very  complete  and 
minute  study  of  a  case  that  some  simple,  trifling 
detail  is  the  cause  of  immense  misery  and  suffering. 
For  this  reason  the  discomfort  of  a  seemingly  prying 
examination  is  a  necessary  evil.  Fortunately  at  the 
present  time  there  are  clinical  tests  that  can  be  made 
without  the  patient'3  knowledge  and  which  elimi- 


EDITOR'S  NOTES  317 

nate  the  necessity  for  certain  cross  questioning  that 
is  painful  alike  to  physician  and  patient.  In  fact, 
it  is  generally  found  that  the  statements  made  by 
a  patient  regarding  his  or  her  condition  are  in  the 
majority  of  cases  hopelessly  incorrect,  and  the  im- 
portant details  may  be  secured  in  a  conversation  of 
a  few  minutes,  the  real  details  being  left  to  the 
laboratory. 

Chapter  III 

WHAT    MEDICINE    HAS    NOT    ACCOMPLISHED   AND 
WHAT    IT    HAS 

In  this  chapter  the  author  adopts  a  bitter  atti- 
tude that  is  scarcely  fair.  "To  diagnose  ex-juvanti- 
bus"  has  been  termed  in  America  "The  Therapeutic 
Test"  and  has  passed  almost  out  of  existence  within 
the  past  few  years,  although  it  is  still  found  in  the 
country  where  clinical  laboratory  work  is  difficult 
to  obtain.  In  the  author's  description  of  his  exam- 
inations of  patients  with  soft  cancer  of  the  kidney 
it  would  seem  to  the  careful  reader  that  he  had 
allowed  his  contempt  for  the  science  to  interfere 
with  his  work.  His  awakening  in  the  latter  half  of 
the  chapter  to  the  possibilities  in  medical  diagnosis 
seems  belated. 

When  he  deals  with  the  deficiency  of  the  present 
system  of  examinations  in  the  medical  schools  he 
touches  a  very  vital  point  and  his  criticism  is  well 


3i8    THE  MEMOIRS  OF  A  PHYSICIAN 

taken.  Improvement  along  this  line  has  been  very 
great  in  the  past  ten  years.  Students  in  the  large 
university  hospitals  are  credited  little  on  the  result 
of  the  final  examination  in  any  subject.  Their 
daily  work  in  the  laboratory  and  in  the  "Ward 
Class,"  their  general  attitude  of  mind  toward  their 
work  is  taken  into  more  serious  consideration.  In 
addition  to  this  a  new  system  has  sprung  up  recently 
in  the  form  of  Quiz  Classes  conducted  by  instructors 
outside  of  the  regular  hours.  In  these  classes  prac- 
tical work  is  gone  over  again  and  again  and  funda- 
mental principles  are  grounded  so  thoroughly  that 
the  students  find  the  final  examination  a  mere  mat- 
ter of  form. 

Chapter  IV 

DIFFICULTIES    THAT    CONFRONT   THE    PRACTITIONER 

In  this  chapter  the  author  shows  how  hope- 
lessly unfitted  for  the  practice  of  medicine  is  the 
recent  graduate  from  the  medical  school.  No  one 
knows  this  incompetence  better  than  the  doctor 
himself  and  this  knowledge  increases  his  diffidence, 
and  decreases  what  little  respect  the  possession  of 
a  degree  gives  him  in  the  eyes  of  the  world.  The 
world  famous  surgeon  Marion  Sims,  in  his  book, 
"The  Story  of  My  Life,"  reviews  his  own  experi- 
ences in  the  early  practice  of  medicine  that  are  so 
parallel  with  those  of  the  author  of  "The  Memoirs 


EDITOR'S  NOTES  319 

of  a  Physician"  that  they  should  be  read  in  con- 
junction with  this  book. 

In  commenting  upon  the  mistake  in  diagnosis  of 
the  case  of  pneumonia  it  may  be  said  that  there  is 
scarcely  a  physician  who  has  not  had  similar  hu- 
miliating experiences,  although  one  must  remember 
that  such  a  mistake  is  easily  made  where  the  pneu- 
monia begins  in  the  central  portion  of  the  lung  and 
the  physical  signs  of  consolidation  are  not  in  evi- 
dence until  late  in  the  course  of  the  disease.  Pa- 
tients have  been  not  infrequently  operated  upon  for 
appendicitis  when  the  trouble  was  in  reality  pneu- 
monia. The  case  of  rheumatism  described  presents 
an  interesting  medical  problem  in  itself.  Within 
the  past  ten  years  this  disease  has  become  separated 
from  the  general  category  of  acute  infections  and 
regarded  more  as  a  poisoning  of  the  system  from 
some  focus  probably  obscure,  and  the  treatment  of 
it  to-day  is  aimed  at  the  removal  of  such  a  focus 
rather  than  the  relief  of  symptoms  through  the  giv- 
ing of  drugs.  It  would  seem  that  the  author  of  the 
Memoirs  had  little  cause  to  reproach  himself  for 
the  failure  of  this  line  of  treatment  at  the  time  he 
practised  medicine.  The  description  of  the  old 
doctor  coming  to  the  rescue  in  the  case  of  Typhoid 
Fever  is  admirable  as  it  shows  one  of  the  triumphs 
of  practical  experience  over  theory.  The  cause  of 
general  Sepsis  following  Scarlet  Fever  is  worthy  of 
comment  but  reflects  less  discredit  on  the  author 


320    THE  MEMOIRS  OF  A  PHYSICIAN 

than  he  seems  to  suggest.  It  seems  improbable  that 
he  did  as  much  harm  in  the  application  of  the  oint- 
ment to  the  swollen  glands  as  he  allows  us  to  believe. 

Chapter  V 

YOUNG    DOCTORS    AND    TECHNIC 

This  chapter  reflects  an  amount  of  perseverance 
and  singleness  of  purpose  on  the  part  of  the  young 
physician  that  is  remarkable.  Here  as  in  other 
points  of  his  narrative  he  shows  such  deep  appre- 
ciation of  his  responsibilities  that  the  reader  cannot 
but  be  impressed. 

Chapter  VI 

SURGERY,    ITS    RISKS    AVOIDABLE    AND    INEVITABLE 

One  can  scarcely  read  this  chapter  without  realis- 
ing two  things :  First  of  all,  the  dangers  of  surgery 
in  the  hands  of  men  unqualified  for  that  branch  of 
the  medical  profession,  and,  secondly,  the  triumphs 
of  surgery  in  skilful  hands.  Glancing  over  the 
chapter,  one  is  impressed  with  the  fact  that  the 
author  was  never  adapted  mentally  or  physically 
for  the  practice  of  surgery.  His  thoughtful  intro- 
spective mind  predisposed  towards  hesitancy,  and 
his  overdeveloped  conscience  stir  his  nerves  into 
such  a  state  of  confusion  that  he  is  unable  to  carry 
out  even  minor  operations  successfully.     In  the  past 


EDITOR'S  NOTES  321 

lew  years  the  practice  of  medicine  and  surgery  are 
becoming  more  and  more  separate  and  wiser  men 
of  the  profession  are  leaving  their  operative  work 
to  those  best  qualified  to  handle  it.  This  is  a  sensi- 
ble measure  and  it  is  probable  that  within  a  few 
years  no  man  will  be  allowed  to  practice  surgery 
unless  he  is  possessed  of  a  separate  and  distinct  de- 
gree in  addition  to  his  regular  medical  certificate. 
As  regards  the  problem  of  allowing  young  surgeons 
to  gain  their  experiences  on  patients  a  great  deal 
must  be  said  pro  and  con.  The  teachings  of  the 
medical  schools  of  the  present  day  are  for  the  most 
part  so  thorough  and  students  have  such  unlimited 
opportunities  for  watching  the  operations  that  the 
ground  work  of  their  surgical  knowledge  is  fairly 
complete.  In  addition  to  this  a  year's  service  as  resi- 
dent in  a  hospital  is  compulsory.  During  this  time 
they  are  allowed  to  assist  at  operations  and  later 
operate  under  the  directions  of  the  surgeon.  After 
this  if  the  young  man  decides  to  take  up  surgery 
as  a  specialty  he  practically  gives  up  all  thought  of 
making  a  living  for  several  years  and  devotes  his 
time  to  dispensary  work  and  in  being  assistant  to 
a  surgeon  in  some  large  hospital.  As  his  experience 
increases,  his  confidence  in  his  own  ability  increases, 
and  he  is  able  at  the  end  of  seven  to  ten  years  to 
take  up  surgical  work  by  himself.  The  necessity 
for  an  utterly  inexperienced  man  to  take  the  re- 
sponsibility of  operating  on  a  patient  is  obviated, 


322     THE  MEMOIRS  OF  A  PHYSICIAN 

Chapter  VII 

IN    MEDICINE NOTHING   RISKED,    NOTHING   GAINED 

Here  the  author  deals  with  a  problem  that  is 
ever  present.  In  the  majority  of  cases,  however, 
the  trial  of  a  new  remedy  is  first  preceded  by  a 
fundamental  knowledge  of  certain  facts  that  indi- 
cate what  the  value  of  that  remedy  would  be  under 
certain  conditions.  Next  it  is  warily  tried  where 
other  measures  have  failed  and  its  results  are 
carefully  judged.  Here  as  elsewhere  laboratory 
analyses  give  their  important  clues  as  to  its  value, 
and  it  is  adopted  by  the  profession  only  after  most 
careful  and  painstaking  research.  It  is  interesting 
in  this  regard  to  note  the  fact  that  as  our  clinical 
knowledge  of  the  action  of  drugs  increases,  the  num- 
ber of  drugs  used  decreases.  In  other  words,  we 
have  come  to  find  out  that  drugs  such  as  we  used 
ten  years  ago  have  so  little  real  value  that  their 
administration  has  been  almost  abandoned.  The 
real  triumph  of  modern  medicine  has  come  to  be  the 
fostering  of  the  patient's  own  resistance  to  disease 
and  supplementing  the  bodily  resources  by  measures 
which  can  help  the  individual  to  throw  off  the  in- 
fection. Drugs  are  playing  a  more  and  more  sec- 
ondary part.  Pneumonia  is  treated  by  fresh  air, 
easily  assimilated  food,  appropriate  stimulation. 
The  same  is  true  of  almost  every  infection.     A  few 


EDITOR'S  NOTES  323 

"specifics"  are  used,  such  as  Quinine  in  Malaria  and 
the  like.  The  laboratory  shows  us  that  evidence  of 
the  disease  disappears  from  the  blood  after  the  in- 
gestion of  the  drug.  Particularly  in  children's  dis- 
ease is  the  use  of  drugs  becoming  more  and  more 
obsolete.  Certain  pediatrists  boast  that  their  thera- 
peutics in  children's  diseases  consist  of  appropriate 
diet,  castor  oil,  plenty  of  sleep  and  a  rectal  tube. 
Regarding  the  operation  for  goitre  it  is  a  well  known 
fact  that  the  failure  of  this  operation  was  due  to 
the  removal  of  the  Para  Thyroids.  Since  these 
have  been  left  intact  the  operation  has  been  more 
successful. 

Chapter  IX 

MEDICINE    AN    ART,    NOT    A    SCIENCE 

In  this  chapter  the  author  takes  a  distinctly  pessi- 
mistic view  of  the  medical  science  and  it  seems  as 
if  he  had  missed  some  of  the  most  important  details 
of  his  studies.  He  calls  attention  to  the  various 
changes  in  treatment  that  have  taken  place  over  a 
period  of  years  and  scoffs  at  them,  but  he  seems  to 
lose  sight  of  the  fact  that  each  of  these  probably 
accomplished  a  great  deal  when  administered  in 
given  cases.  The  fact  that  none  of  them  were  alto- 
gether satisfactory  simply  emphasises  the  fact  that 
medicine  is  not  an  exact  science  and  it  is  the  untir- 
ing, incessant  study  of  the  individual  and  adapta- 


324     THE  MEMOIRS  OF  A  PHYSICIAN 

tion  of  a  given  course  of  therapeutics  to  individual 
cases  that  accomplishes  any  good. 

Chapter  X 

THE    QUESTION    OF    VIVISECTION 

Here  the  author  deals  with  one  of  the  most 
mooted  questions  in  the  profession.  How  far  hu- 
man beings  have  the  right  to  perform  experiments 
on  living  animals  is  a  matter  that  must  be  consid- 
ered very  carefully.  Certain  it  is  that  no  thought- 
ful, truly  Christian  man,  whether  he  be  a  scientist 
or  not,  would  cause  an  animal  suffering.  Stories 
reach  our  ears  of  vivisection  that  are  too  horrible  to 
be  admitted.  If  they  be  in  a  measure  true,  then 
law  should  step  in  and  prevent  their  recurrence. 
However,  in  the  present  day,  vivisection  in  the 
medical  schools  is  mainly  confined  to  the  inocula- 
tion of  guinea  pigs  and  rabbits  and  operations  upon 
animals  under  ether  or  chloroform  anaesthesia,  and 
under  the  same  aseptic  precautions  as  would  be  em- 
ployed in  actual  operations  upon  human  beings.  If 
there  was  at  one  time  a  disregard  of  the  feelings  of 
dumb  animals,  those  who  have  had  opportunity  to 
observe  the  work  in  modern  medical  schools  cannot 
but  realise  that  such  is  not  the  case  at  the  present 
time.  The  tendency  now  is  to  eliminate  experi- 
ments upon  animals  by  students  except  under  the 
close  direction  of  instructors.     The  anti-vivisection- 


EDITOR'S  NOTES  325 

ists  have  much  on  their  side  of  the  problem;  prob- 
ably too  much  has  been  done  in  the  past  to  cause 
suffering  among  animals.  On  the  other  hand  it  is 
not  altogether  reasonable  to  place  the  life  of  a  mis- 
erable street  dog  above  that  of  a  human  being. 
There  is  no  question  but  that  infinite  value  has  come 
from  vivisection;  perhaps  it  has  been  abused,  but  in 
the  progress  of  the  world  such  abuses  will  be  done 
away  with.  As  regards  the  inoculation  of  animals 
with  disease,  let  it  be  said  that  the  nervous  system 
of  animals  such  as  guinea  pigs,  rabbits,  and  rats  is 
not  highly  organised  and  it  is  extremely  improbable 
that  such  inoculations  cause  much  suffering.  The 
value  of  this  animal  inoculation  has  been  shown  be- 
yond a  shadow  of  a  doubt  in  the  lessening  of  the 
death  rate  of  Diphtheria  to  such  an  extent  that  the 
disease  is  no  longer  held  in  the  dread  that  it  once 
was.  The  same  is  true  of  Tetanus  (Lock-jaw), 
Meningitis  and  other  diseases.  It  is  no  more  rea- 
sonable to  have  vivisection  absolutely  abolished 
than  it  is  to  have  slaughter  houses  forbidden  by  law. 
The  problem  concerns  us  more  how  vivisection 
should  be  practised,  rather  than  whether  or  not  it 

should  exist. 
J* 

Chapter  XI 

THE    UNCERTAINTY    OF    DIAGNOSIS 

Here  the  author  deals  with  the  hideous  mistakes 
that  are  the  nightmare  of  the  profession.     Until  our 


326     THE  MEMOIRS  OF  A  PHYSICIAN 

science  becomes  an  exact  science  we  shall  ever  be 
confronted  with  them.  The  best  we  can  hope  to 
do  is  to  subject  our  patients  to  the  most  careful  ex- 
aminations that  are  possible  in  order  to  lessen  the 
number  of  our  errors. 


Chapter  XII 

DOCTOR   AND    PATIENT 

The  author  touches  on  a  sore  point  when  he  deals 
with  the  ignorance  of  most  persons  with  ordinary 
medical  subjects.  If  we  are  to  develop  the  science 
of  medicine  as  it  should  be  developed  the  public  at 
large  should  know  more  than  it  does  about  the  prin- 
ciples that  underlie  it.  The  time  is  passed  when 
the  doctor  could  be  considered  a  sort  of  a  magician 
who  casts  a  spell  over  the  malady.  The  further  we 
go  in  the  study  of  the  ills  of  the  human  body  the 
more  we  realise  how  simple  are  some  of  the  princi- 
ples of  diet,  hygiene  and  sanitation,  and  how  easily 
they  can  be  understood  by  persons  of  ordinary  in- 
telligence. There  are  very  few  principles  of  medi- 
cine that  cannot  be  explained  in  simple  terms. 
There  are  things  which  could  be  taught  in  our  public 
schools  which  would  undoubtedly  tend  toward  the 
rearing  of  a  healthier,  saner  race.  If  these  princi- 
ples were  taught  there  would  be  less  overcrowding 
of  factories,  streets  would  be  kept  clean,  water  sup- 


EDITOR'S  NOTES  3^7 

plies  would  be  kept  free  of  pollution,  contagious 
diseases  would  soon  be  unusual. 

Chapter  XIII 

THE    DOCTOR    AND    THE    POOR 

This  is  a  social  problem  to  be  met  by  the  public 
at  large.  Social  service  workers  connected  with  the 
large  hospitals  have  done  a  wonderful  amount  of 
good  in  teaching  the  poor  how  to  live  on  slender 
incomes  and  how  to  carry  out  the  directions  of  the 
attending  physician.  As  time  goes  on  the  public 
will  understand  that  squalor  and  filth  and  disease 
in  one  quarter  of  a  city  menaces  the  health  and  pros- 
perity of  another  quarter,  and  steps  will  be  taken  to 
keep  such  conditions  from  even  existing. 

Chapter  XIV 

MEDICINE,    NATURAL    SELECTION    AND    THE 
SURVIVAL    OF    THE    UNFIT 

The  author  takes  an  attitude  than  man  is  retro- 
gressing rather  than  advancing  in  physical  condi- 
tion. The  logic  of  his  argument  is  not  clear.  He 
has  allowed  himself  to  wander  into  a  maze  of  pos- 
sibilities that  are  not  within  the  bounds  of  reason. 
Perhaps  the  practice  of  medicine  in  some  instances 
does  strive  towards  the  survival  of  the  unfit,  but  can 
we  not  see  many  instances  all  around  us  of  puny 


328     THE  MEMOIRS  OF  A  PHYSICIAN 

children  who  a  score  of  years  ago  would  have  died 
miserably,  but  are  now  reared  to  healthy  manhood 
and  womanhood  by  reason  of  the  correction  of 
physical  deformities.  Are  not  the  children  of  these 
puny  specimens  frequently  the  most  healthy  in  a 
given  community?  Undoubtedly  so.  The  science 
of  medicine  is  advancing  along  the  lines  of  common 
sense,  teaching  people  how  to  live  that  they  may  be 
healthy.  It  is  striving  toward  the  attainment  of 
the  goal  where  medicine  itself  will  cease  to  have  any 
cause  for  existence.  The  summit  of  our  hopes  as 
practitioners  of  medicine  will  be  reached  when  our 
services  are  no  longer  required. 

Chapter  XV 

MENTAL    PROGRESS   AND    PHYSICAL   DEGENERATION 

There  is  hardly  any  comment  necessary  upon  this 
chapter.  Mental  progress  must  always  go  hand  in 
hand  with  physical  ability.  No  man  can  continue 
mental  work  without  sufficient  physical  vigour  to 
supply  food  in  the  form  of  blood  and  tissue  to  his 
brain.  It  is  true  that  a  man's  brain  is  more  highly 
organised  than  that  of  an  animal  and  that  generally 
speaking  a  human  being  is  the  weakest  of  animals 
physically,  yet  it  is  undoubtedly  true  that  with  com- 
paratively little  difficulty  man  may  train  himself 
physically  so  that  he  is  able  to  perform  feats  of  en- 
durance that  cannot  be  equalled  by  any  other  animal. 


EDITOR'S  NOTES  329 

A  trained  runner  can  tire  out  a  horse  or  a  dog  or 
even  a  deer  by  reason  of  his  highly  developed  nerv- 
ous system.  A  man  can  bring  his  body  under  con- 
trol and  use  it  to  better  advantage  than  any  other 
animal.  Whether  he  does  this  or  not  rests  with 
the  individual  himself.  It  does  not  require  genera- 
tions for  man  to  adapt  himself  to  surrounding  con- 
ditions. He  can  live  where  other  animals  cannot; 
he  can  stand  extremes  of  cold  and  heat  that  other 
animals  cannot;  in  short,  he  is  probably  the  most 
adaptable  animal  that  exists  in  the  world.  Do 
these  facts  suggest  retrogression  or  progress? 

Chapter  XVI 

SHAME    AND    THE    PHYSICIAN 

The  author  has  probably  purposely  overdrawn  his 
pictures,  and,  while  worthy  of  consideration,  this 
does  not  seem  to  be  one  of  the  vital  problems  that 
concern  the  profession. 

Chapter  XVII 

WHEN    THE    PATIENT    DIES 

Such  harrowing  scenes  as  are  here  depicted  hap- 
pen as  a  result  of  ignorance  pure  and  simple.  When 
the  public  is  educated  as  to  what  a  physician  is  try- 
ing to  do  and  is  able  to  judge  his  merits  or  demerits, 
such  occurrences  will  be  rare.     Physicians  of  the 


330    THE  MEMOIRS  OF  A  PHYSICIAN 

present  day  do  not  meet  with  such  problems  as  often 
as  they  did  in  the  past, — extremes  of  gratitude  and 
hate,  as  has  been  said  before,  are  unusual.  The 
recovery  of  a  patient  under  a  doctor's  care  is  not 
considered  miraculous  unless  the  physician  has  ac- 
tually done  something  that  is  phenomenal  by  reason 
of  his  skill  in  handling  a  knife  or  pulmotor.  Credit 
is  given  to  him  more  on  account  of  his  personal  at- 
tention and  unfailing  interest  than  on  his  book 
knowledge. 

Chapter  XVIII 

THE    PROFESSIONAL    MANNER 

Indifference  is  not  as  necessary  as  the  author  would 
lead  us  to  believe;  on  the  contrary,  fellow  feeling, 
cheerfulness  and  singleness  of  purpose  are  more  im- 
portant; encouragement  and  frankness  are  always 
appreciated  and  evenness  of  temper  is  essential. 

Chapter  XIX 

DOCTORS    AND    MONEY 

Here  is  one  of  the  vital  problems  of  medicine. 
The  author  has  dealt  with  it  clearly.  Once  a 
famous  specialist  was  asked  to  describe  the  profes- 
sion of  medicine.  He  said,  "It  is  one  of  the  grand- 
est professions  in  the  world  but  a  horrible  business." 
Physicians  are  under  paid  and  wrongly  so,  but  this 


EDITOR'S  NOTES  331 

is  due  to  a  lack  of  understanding  as  to  what  their 
ability  means.  It  seems  exorbitant  for  a  doctor  to 
charge  five  dollars  for  a  personal  interview  lasting 
a  few  minutes,  but  if  physicians  are  to  exist  they 
must  have  the  means  wherewith  to  live,  and  the 
expense  of  medical  education  is  enormous.  There 
is  scarcely  a  physician  who  does  not  feel  that  he 
would  prefer  to  eliminate  the  necessity  to  charge  his 
patients  for  his  services.  The  personal  element  in 
the  practice  of  medicine  is  so  essential  and  yet  so 
sacred  that  it  can  scarcely  be  placed  on  a  mercenary 
basis.  The  simplest  plan  of  meeting  this  great 
question  would  be  to  have  every  individual  required 
by  law  to  withhold  a  certain  per  cent  of  his  income, 
no  matter  how  small  it  might  be,  and  turn  this  over 
to  a  properly  appointed  official  or  bureau.  This 
officer  in  turn  should  use  it  in  recompensing  the 
physician  who  attends  the  family  of  the  man  upon 
presentation  of  an  itemised  account  of  the  services 
rendered  on  a  definite  basis  of  specific  charges.  In 
this  way  the  pecuniary  matters  which  now  hamper 
both  physician  and  patient  would  become  negligible 
and  there  would  be  no  tendency  on  the  part  of  the 
patient  to  avoid  payment  and  no  hesitancy  in  send- 
ing for  a  physician  at  the  proper  time.  The  details 
of  such  an  arrangement  could  be  worked  out  by  a 
properly  appointed  commission,  and  such  a  system 
would  work  great  good  besides  eliminating  the  ques- 
tion of  how  much  to  charge  the  individual. 


APPENDIX  B 

(This  is  Chapter  VIII  of  the  original  Russian. 
For  fairly  obvious  reasons  it  has  seemed  wisest  to 
print  it  as  an  appendix  in  this  version.) 

EXPERIMENTS  ON    LIVING  MEN   AND   WOMEN 

For  the  nonce  I  will  take  leave  of  those  tangled 
and  difficult  problems,  which  I  am  at  a  loss  to 
solve,  and  in  the  face  of  which  I  must  confess  utter 
helplessness.  I  will  now  occupy  myself  with  a  ques- 
tion to  which  but  one  answer  is  possible,  and  that  a 
perfectly  straight  one.  It  deals  with  gross  and  en- 
tirely conscious  disregard  for  that  consideration 
which  is  due  to  the  human  being. 

I  approach  the  subject  with  regret,  but  it  is  im- 
possible to  pass  it  by. 

"A  certain  Dr.  Koch,"  we  read  in  the  Russian 
medical  paper,  Fhysician^  "has  published  a  pam- 
phlet, entitled,  'Aerztliche  Versuche  an  lebenden 
Menschen'  ('Medical  Experiments  on  Living  Man'), 
than  which  nothing  were  better  calculated  to  further 
undermine  the  respect  for,  and  confidence  of  the 
laity  in,  our  profession.  The  author  essays  to  prove 
that  'vivisection  has  long  crossed  the  thresholds  of 
our  hospitals' — in  other  words,  that  experiments 
similar  tQ  those  conducted  upon  the  lower  ammals 

33« 


EXPERIMENTS  ON  MAN  333 

in  the  laboratory,  are  practised  on  living  man  in  our 
infirmaries.  As  might  have  been  expected,  Koch's 
book  was  immediately  seized  upon  by  different  feu- 
illeton  writers  and  newspaper  chroniclers.  It  were 
highly  desirable  that  our  German  colleagues  should 
not  leave  a  single  one  of  Dr.  Koch's  'facts'  without 
searching  inquiry  and  explanation,  as  it  is  only  pos- 
sible by  this  means  to  nullify  the  effect  of  his 
book."  \ 

I  have  not  read  the  above-mentioned  pamphlet, 
and  do  not  know  how  far  the  "facts"  mentioned  by 
Dr.  Koch  merit  the  ironical  inverted  commas  which 
the  editor  of  the  Fhysician  had  seen  fit  to  place  them 
in.  But  unfortunately  there  is  much  substantial 
truth  even  in  the  title  of  Dr.  Koch's  booklet  alone. 
In  proof  of  the  above  it  would  be  easy  enough  to 
adduce  a  very  long  array  of  facts- — facts  of  such 
a  nature,  too,  that  they  could  not  be  bracketed  in 
inverted  commas,  for  this  simple  reason — they  are 
substantiated  in  black  and  white  by  the  perpetrators 
themselves. 

As  we  proceed,  I  shall  point  out  the  original 
sources  of  my  information  with  every  possible  care, 
that  the  reader  may  verify  my  statements. 

I  shall  restrict  myself  to  the  venereal  diseases. 
Notwithstanding  the  delicacy  of  the  subject,  I  was 
compelled  in  my  choice  to  single  out  the  above, 
because  they  furnish  us  with  the  greatest  wealth 

^  See  The  Physician,  1893,  p.  906. 


334     THE  MEMOIRS  OF  A  PHYSICIAN 

of  the  facts  I  wish  to  draw  public  attention  to.  For 
venereal  complaints  are  the  exclusive  lot  of  man, 
and  not  a  single  one  of  them  can  be  transmitted  to 
the  lower  animals/  Owing  to  this,  many  questions 
which,  in  other  branches  of  medicine,  find  their  an- 
swer in  experiments  on  animals,  can,  in  venerology, 
only  be  decided  through  human  inoculation,  and 
venerologists  have  not  hesitated  to  take  the  plunge : 
crime  stains  every  step  made  by  their  science. 

As  is  well  known,  three  varieties  of  venereal  dis- 
ease exist:  gonorrhoea,  soft  ulcer  and  syphilis.  I 
shall  commence  with  the  first  named. 

The  specific  micro-organism  of  gonorrhoea  was 
discovered  by  Neisser  in  1879.  His  experiments, 
conducted  with  exemplary  care,  tended  to  prove, 
with  a  considerable  degree  of  probability,  that  the 
gonococcus  he  had  discovered  was  the  specific  agent 
of  that  disease.  But  in  bacteriology  the  proof  posi- 
tive of  the  specific  quality  of  any  micro-organism 
is  only  absolute  when  obtained  through  inoculation; 
if,  on  inoculating  an  animal  with  a  pure  culture  of 
the  micro-organism,  we  call  forth  a  given  disease, 
this  fact  proves  that  the  above  micro-organism  is  the 
specific  agent  of  the  latter.  Unfortunately,  not  a 
single  animal,  as  we  already  know,  is  liable  to  gonor- 
rhoea. Either  the  discovery  had  to  remain  doubtful, 
or  else  it  was  necessary  to  inoculate  man.  For  him- 
self, Neisser  chose  the  first  alternative. 

1  It  has  been  possible  to  infect  monkeys  with  syphilis. 


EXPERIMENTS  ON  MAN  335 

His  followers  were  not  so  nicely  conscientious. 
The  first  to  inoculate  man  with  gonococcus  was  Dr. 
Max  Bockhart,  assistant  to  Professor  Rinecker. 

''Geheimrath  von  Rinecker,"  writes  Bockhart, 
''held  the  view,  that  the  discovery  of  the  causes  of 
venereal  disease  was  only  possible  through  the  in- 
oculation of  human  beings."  ^  Acting  upon  the  sug- 
gestion of  his  patron,  Bockhart  inoculated  a  patient 
suffering  from  creeping  paralysis  in  its  last  stages 
with  a  pure  culture  of  gonococcus:  a  few  months 
previously  the  patient  had  lost  his  sense  of  feeling 
and  his  death  was  awaited  very  shortly. 

The  inoculation  proved  successful,  but  the  dis- 
charge was  very  insignificant.  To  increase  it,  the 
patient  was  given  half  a  litre  of  beer.  ''The  suc- 
cess was  brilliant,"  writes  Bockhart;  "the  dis- 
charge became  very  copious.  .  .  .  Ten  days  after 
inoculation  the  patient  died  of  a  paralytic  fit.  Au- 
topsy showed  acute  gonorrhoeic  inflammation  of  the 
urethra  and  bladder,  with  incipient  kidney  mortifi- 
cation, and  a  large  number  of  abscesses  in  the  left 
kidney;  numerous  gonococci  were  found  in  the  pus 
taken  from  these  abscesses."  ^ 

The  methods  of  pure  culture  employed  by  Bock- 
hart were  very  crude,  and  his  experiment  had  but 
small  scientific  value.     The  first  undoubtedly  pure 

2  "Beitrag  zur  Aetlologie  desHarnrohren  trippers":  Vierteljahr- 
schr.  fur  Dermatol,  und  Syphilis,  1883,  p.  7. 

^Beitrag  zur  Aetlologie  des  Karnrohrentrippers":  Vierteljahr- 
schr.  fiir  Dermatol,  und  Syphilis,  1883,  PP*  7-10. 


336    THE  MEMOIRS  OF  A  PHYSICIAN 

culture  of  gonocoecus  was  obtained  by  Ernst  Bumm.* 
To  prove  that  it  was  the  specific  agent,  Bumm,  by 
means  of  a  platinum  wire,  introduced  the  culture 
into  a  woman's  urethra,  which  had  been  found  per- 
fectly healthy  after  repeated  examinations.  Typ- 
ical urethritis  developed  which  required  six  weeks 
for  its  cure  {op.  cit,  p.  147).  Studying  the  various 
peculiarities  of  his  cultures,  Bumm  inoculated  his 
gonocoecus  upon  another  woman  in  the  same  man- 
ner, obtaining  an  identical  result  (p.  150).  Here 
we  must  note  that,  more  than  twenty  years  pre- 
viously, Noeggerath  proved  how  serious  and  painful 
were  the  effects — especially  in  the  case  of  women, 
following  so-called  ''innocent"  gonorrhoea,  which 
the  ignorant  even  now  speak  of  with  a  smirk,  al- 
though science  has  long  ceased  to  have  any  doubts 
on  the  matter  whatever.  This  is  what  such  an  au- 
thoritative specialist  in  these  matters  as  Neisser,  of 
whom  we  have  already  had  occasion  to  speak,  de- 
clares: "I  do  not  hesitate  to  state  that  in  its  after 
effects,  gonorrhoea  is  an  incomparably  more  dan- 
gerous (ungleich  Schlimmer)  disease  than  syphilis^ 
and  I  think  that  all^  especially  gynaecologists^  will 
agree  with  meT  ^  Bumm  himself  declares,  in  the 
preface  to  his  work,  that  "gonorrhoeic  infection  is 

*  E.  Bumm,  "Die  Micro-organismus  der  gonorrhosichen  Schleim- 
hauterkrankheiten."     2.  Ausg.     Wiesbaden,    1887. 

5  Prof.  Al.  Neisser,  *'Ueber  die  Nothwendigkeit  von  Spezialklin- 
iken  fiir  Haut-und  Venerische-Kranke":  Klinisches  Jahrb.,  Bd.  ii. 
p.  199. 


EXPERIMENTS  ON  MAN  337 

one  of  the  most  important  causes  of  painful  and 
serious  affections  of  the  sexual  organs"  ^ ;  which 
knowledge  did  not,  however,  deter  him  from  subject- 
ing two  of  his  patients  to  such  a  risk.  It  is  true  that, 
according  to  his  accounts,  "every  measure  of  pre- 
caution (?)  against  infection  of  the  sexual  organs" 
was  taken,  but  such  precautions  are  extremely  unre- 
liable. We  may  further  add  that  even  gonorrhoeic 
affection  of  the  urethra  alone  is  sufficient  to  cause 
the  most  painful  complications  later. 

The  next  step  in  the  culture  of  the  gonococcus 
was  made  by  Dr.  Ernst  Wertheim,''^  who  succeeded 
in  obtaining  a  pure  culture  on  plates.  "To  prove 
conclusively,"  writes  Wertheim,  "that  the  colonies 
growing  on  the  plates  were  really  those  of  Neisser's 
gonococci,  it  was  naturally  necessary  to  perform 
inoculation  upon  the  urethra  of  man."  Wertheim 
inoculated  four  paralytic  patients  with  his  culture  ^' 
and  also  a  certain  S.  (an  idiot  of  thirty-three). 
"Fairly  abundant  discharge  was  still  noticeable  in  S. 
two  months  after  inoculation."  ®  Wertheim  made 
no  further  experiments  "owing  to  lack  of  suitable 
material."  ^ 

^  op.  cit.,  p.  iv. 

■^  Provisional  report  in  the  Deutsche  tned.  Wochenschrift,  1891, 
No.  50  ("Reinziichtung  des  Gonococcus  Neisser  mittels  des  Plat- 
tenverfahrens").  Detailed  description  in  Archiv  fur  Gynaecologies 
Bd.  42  (1892):  "Die  ascendirende  Gonorrhoe  beim  Weibe." 

^Archiv,  pp.  17,  28,  33-34,  37,  39. 

^I^will  here  draw  attention  to  the  fact  of  Wertheim  having  in- 
jected pure  culture  of  gonococcus  into  his  own  body — each  time 
with  positive  results. 


338     THE  MEMOIRS  OF  A  PHYSICIAN 

Wertheim's  methods  were  verified  by  other  in- 
vestigators. Gebhard  ^^  was  successful  in  his  inocu- 
lation of  Wertheim's  culture  upon  human  beings 
(no  details  are  given  on  his  work).  The  experi- 
ments of  Karl  Menge  also  furnished  positive  results : 
he  inoculated  a  woman  suffering  from  a  vesico- 
vaginal carcinomatous  fistula,  with  gonococcus;  it 
was  he  also,  who  inoculated  a  woman,  suffering 
from  tumour  on  the  brain,  with  gonorrhoea,  two  days 
before  her  death. ^^ 

But  especially  comprehensive  were  the  experi- 
ments of  Finger,  Ghon  and  Schlangenhaufen.^^ 
They  inoculated  fourteen  patients,  all  of  them  hope- 
less cases,  chiefly  consumptives,  who  mostly  died 
from  three  to  eight  days  after  inoculation.  "Ex- 
tremely valuable  histological  material  was  furnished 
by  the  patient  F.  D.,  21,  who  died  three  days  after 
inoculation.  Taking  into  consideration,"  remarked 
the  joint  authors,  "the  short  duration  of  the  process, 
which  lasted  but  three  days,  one  is  surprised  at  its 
intensity,  which  caused  such  deep  histological 
changes." 

Gonorrhoea  is  one  of  the  commonest  causes  of 
inflammation  of  the  eyes  in  newly-born  infants. 
Many  investigators  studied  the  relationship  of  gon- 

10  "Der  Gonococcus-Neisser  auf  der  Platte  u.  in  Reincultur": 
Berlin,  klin.  Woch.,  No.  ii,  p.  258. 

11  "Ein  Beitrag  zur  Kultur  des  Gonococcus":  Centralblatt  fur 
Gynaecologie,  1893,  No.  8. 

12  "Zur  Biologic  des  Gonococcus" :  Archiv  fur  Dermatologte  und 
Syphilis,  Bd.  28,  1894,  pp.  304-306,  317-324- 


EXPERIMENTS  ON  MAN  339 

ococcus  to  eye-disease  in  newly-born  children.  E. 
Fraenkel  inoculated  the  eyes  of  infants,  which  could 
not  have  lived  in  any  case,  with  the  inflammatory 
secretions  of  gonorrhoeic  patients.  One  of  the 
infants  lived  for  ten  days  after  inoculation,  de- 
veloping typical  purulent  inflammation  of  the 
eyes.^^ 

Tischendorfl  inoculated  the  eyes  of  atrophic  chil- 
dren with  gonorrhoeic  discharge  of  little  girls  suf- 
fering from  that  disease:  purulent  inflammation, 
with  characteristic  gonococci,  was  the  result.  ^^ 
Kroner  inoculated  six  adult  blind  persons  with  the 
muco-purulent  discharge  of  pregnant  and  parturient 
women  (with  negative  results). ^^ 

Such  is  the  very  incomplete  history  of  gonorrhoea 
from  the  standpoint  which  interests  us.  I  now 
ought  to  pass  on  to  the  inoculation  of  soft  ulcer 
(ulcus  molle)^  but  I  need  not  tarry  for  the  purpose: 
firstly,  because  such  inoculations  are  comparatively 
harmless  in  their  after-effects — the  investigator 
merely  inoculates  the  patient's  shoulder,  thigh  or 
abdomen  with  the  ulcer  and  heals  it  a  week  or  so 
later;  that  sort  of  thing  is  a  "mere  nothing"  to  the 
patient,  for  is  not  the  living  skin  of  man  "the  most 

^3  "Berlcht  iiber  cine  bei  Kindern  beobachtete  Enderaie  infec- 
tioser  Kolpitis":  Firchoiu's  Archiv,  Bd.  99,  Heft  2  (1885),  pp.  263- 
264. 

^*  "Verhandlungen  der  57  Versammlung  deutscher  Naturforschei* 
u.  Aerzte  in  Magdeburg,  1884":  Archiv  fur  Gynaecologie,  Bd.  25 
(1885),  p.  114. 

'^^  Ibid.,  p.  113. 


340    THE  MEMOIRS  OF  A  PHYSICIAN 


natural  nutritive  milieu  for  the  micro-organism  of 
soft  ulcer  ^"  to  quote  Dr.  Spitschka/^ 

Secondly,  the  sum  total  of  the  above  inoculations 
is  so  great,  that  one  would  have  to  devote  several 
printed  sheets  to  their  description.  Suffice  it  there- 
fore to  mention  the  names  of  Hunter,  Ricord,  Na- 
deau,  Rollet,  Buzenet,  Cuillerier,  Lindwurm,  de 
Luca,  Mannino,  W.  Beck,  Strauss,  Hubbenet, 
Baerensprung,  Ducre,  Kraefting,  Spitschka,  and 
many,  many  others. 

So  we  pass  on  to  syphilis.  Without  going  far 
back  into  antiquity,  I  shall  give  an  account  of  the 
history  of  that  disease  dating  from  the  times  of 
the  celebrated  French  syphilologist,  Philippe  Ricord. 

Ricord  cleared  up  many  obscure  problems  of  his 
specialty  and  entirely  reconstructed  the  science  of 
venerology.  But,  of  course,  he  did  not  escape  error. 
One  of  his  most  lamentable  mistakes  was  the  affirma- 
tion that  syphilis  was  not  contagious  in  its  second- 
ary stage.  This  mistake  was  due  to  the  fact  that 
while  Ricord  performed  endless  inoculations  upon 
venereal  patients^  he  never  ventured  to  experiment 
upon  the  healthy. ^"^  Let  us  see  how  this  fallacy  was 
set  right. 

1^  "Zur  Aetiologie  des  Schankerbulo" :  Archiv  fiir  Dermat.  und 
Syphilis    (1894).     Bd.  28,  p.  32. 

1''^  Rinecker,  referring  to  this  fact,  very  justly  remarks:  "It  is 
hard  to  understand  why  Ricord  condemned  the  inoculation  of 
the  healthy  so  absolutely;  taking  into  consideration  the  vast  num- 
ber of  his  experiments,  he  could  not  have  remained  in  ignorance 
of   the  fact,   that  the   inoculation   of  the   sick  is   not  infrequently 


EXPERIMENTS  ON  MAN  341 

One  of  the  first  to  express  himself  in  favour  of 
secondary  syphilis  being  contagious  was  the  Dublin 
physician,  William  Wallace,  in  his  highly  instruc- 
tive "Lectures  on  Cutaneous  and  Venereal  Disease." 
These  Lectures  are  remarkable  for  the  classical 
shamelessness  with  which  their  author  tells  us  of  his 
criminal  experiments  in  inoculating  healthy  people 
with  syphilis. 

"The  operation  of  inoculation,"  says  he,  "I  per- 
formed in  one  of  three  ways:  firstly,  by  making  a 
puncture  with  a  lancet  and  applying  the  matter  of 
either  an  ulcer  or  the  condylomata  to  the  wound; 
secondly,  by  removing  the  cuticle  with  the  ointment 
of  cantJiarides  and  applying  lint  immersed  in  matter 
to  the  denuded  surface ;  or  else,  thirdly,  by  removing 
the  cuticle  from  a  small  extent  of  surface  with  the 
finger  covered  by  a  towel,  and  by  applying  the  hiat- 
ter  to  the  surface  of  the  cutis  thus  exposed.  The 
results  were  similar."  ^* 

In  his  subsequent  lectures,  he  gives  a  detailed  ac- 
count of  his  inoculations  performed  upon  five  healthy 
individuals  from  19  to  35  years  of  age.  All  de- 
veloped characteristic  syphilis.^^ 

In  his   twenty-second  lecture  Wallace   declared 

dangerous  to  the  latter."  The  sum-total  of  Ricord's  gonorrhoeic 
inoculations,  as  well  as  those  of  syphilis  and  soft  ulcer,  amounted 
to  seven  hundred. 

i^W.  Wallace,  "Lectures  on  Cutaneous  and  Venereal  Diseases": 
The  Lancet  for  1835-36,  vol.  ii.  p.  132. 

18  "Clinical  Lectures  on  Venereal  Diseases":  The  Lancet,  1836- 
X837,  vol.  ii.  pp.  535,  536,  538,  620,  (>2i. 


342     THE  MEMOIRS  OF  A  PHYSICIAN 

that  the  facts  above  mentioned  were  "only  a  portion, 
yes,  a  very  small  portion  of  those  of  a  similar  kind 
which  I  could  adduce."  ^^  In  his  twenty-third  he 
again  lays  stress  on  the  circumstance  that  the  ex- 
periments described  were  only  a  small  part  of  those 
he  had  conducted.^^ 

"Is  it  permissible  to  expect  more  convincing  proofs 
of  the  contagiousness  of  the  secondary  stage  of 
syphilis?"  queries  Dr.  Schnepf,^^  writing  on  the  sub- 
ject of  these  experiments.  "No  further  experiments 
on  the  healthy  are  required.  Wallace's  make  them 
entirely  superfluous.  The  problem  is  solved,  sci- 
ence desires  no  more  victims ;  all  the  worse  for  those 
who  close  their  eyes  to  this  fact." 

But  the  orgy  was  only  about  to  commence.  .  .  . 
In  1851  the  "remarkable  epoch-making"  experi- 
ments of  Waller  were  published.  This  is  how  he 
described  them: — 

"First  experiment:  Durst,  a  boy  of  12,  registra- 
tion number  1396,  suffered  for  a  number  of  years 
from  sores  on  the  head.  Otherwise  quite  healthy, 
never  had  rash  or  scrofula.  As  his  disease  required 
his  detention  in  hospital  for  several  months,  and  as 
he  had  not  suffered  from  syphilis  in  the  past,  I 
found  him  to  be  very  suitable  for  inoculation,  which 

^^Ibid.,  p.  539- 

^^Ibid.,  p.  615. 

22  <'De  la  contagion  des  accidents  consecutifs  de  la  syphilis": 
Annales  des  maladies  de  la  feau  et  du  syphilis.  Publ.  par  A. 
Cazenave.  Vol.  iv.,  1851-52,  p.  44. 


EXPERIMENTS  ON  MAN  343 

was  performed  on  August  6th.  The  skin  of  the 
right  thigh  was  incised  and  the  pus  taken  from  a 
syphilitic  patient  introduced  into  the  fresh  and 
slightly  bleeding  wounds.  I  rubbed  the  matter  into 
the  abrasions  with  a  spatula,  then  I  rubbed  the  scari- 
fied surface  with  lint  soaked  in  the  same  matter,  and 
having  covered  it  with  the  same  lint,  applied  a  band- 
age." About  the  beginning  of  October  the  child 
developed  a  typical  syphilitic  rash.^^ 

"Second  experiment:  Friedrich,  15,  registration 
number  5676,  suffered  for  the  last  seven  years  from 
lupus  of  the  right  cheek  and  the  chin.  Up  to  now 
the  patient  had  not  had  syphilis  and  was  therefore 
eligible  for  inoculation.  This  was  performed  on 
July  27th.  I  introduced  the  blood  of  a  syphilitic 
woman  into  fresh  incisions  made  on  the  left  thigh 
and  then  dressed  the  wounds  with  lint  soaked  in  the 
same  blood."  About  the  beginning  of  October  the 
success  of  the  inoculation  was  beyond  a  doubt.^^ 

*T  showed  both  patients  expressly  to  the  director 
of  the  hospital,  Riedel,"  adds  Waller,  "to  the  head 
physicians  of  the  hospital  (Boehm  and  others),  to 
many  of  the  city  physicians,  to  several  professors 
(Jackisch,  Kubik,  Oppolzer,  Dietrich  and  others), 
to  almost  all  the  hospital  physicians  of  the  city  and 
to  many  foreigners.     All  unanimously  substantiated 

23  Waller,  "Die  Contagiositat  der  secondaren  Syphilis":  Viertel- 
jahrschr.  fiir  d.  prakt.  Heilkunde.  Prag.  1851,  Bd.  I.  (xxix),  pp. 
124-126. 

^^Ibid.,  pp.  126-12?. 


344     THE  MEMOIRS  OF  A  PHYSICIAN 

the  accuracy  of  my  diagnosis  of  the  syphilitic  rash 
and  declared  themselves  ready,  if  necessary,  to  step 
forward  as  witnesses  of  the  reality  of  the  results  of 
my  inoculations." 

Is  not  this  a  complete  and  accurate  .  .  .  criminal 
report?  All  the  details  of  the  "case"  are  communi- 
cated, the  victims  are  indicated  and  the  witnesses 
cited  name  by  name.  ...  If  the  public  prosecutor 
had  peeped  into  this  province,  he  would  have  found 
his  task  wonderfully  simplified. 

Waller's  were  the  signal  for  general  and  universal 
experiments  for  the  verification  of  the  contagious- 
ness of  secondary  syphilis. 

In  March,  1852,  Professor  Rinecker  inoculated  a 
boy  of  12,  suffering  from  incurable  St.  Vitus'  dance, 
with  the  pus  taken  from  a  syphilitic  patient.  After 
the  lapse  of  a  month  the  inoculated  part  developed 
infiltration  and  induration.  There  were  no  con- 
stitutional symptoms  in  this  case.^^ 

In  1855,  at  a  convocation  of  Pfalz  doctors,  while 
the  contagiousness  of  secondary  syphilis  was  under 
discussion  (in  connection  with  Waller's  experi- 
ments), the  assembly  was  acquainted  by  its  secre- 
tary with  the  contents  of  a  communication  received 
from  an  absent  colleague. 

25**Ueber  die  Ansteckungsfahigkeit  der  constitutionellen  Syphilis": 
Fer  hand  lung  en  der  phys.  medic.  Geselbschaft  in  Wurzburg,  Bd.  III. 
(1852),  p.  391.  In  the  clinic  of  the  same  Prof,  Rinecker  two 
physicians,  Drs.  Warneri  of  Lausanne  and  W.  P.,  consented  to  be 
inoculated  and  both  developed  syphilis, 


EXPERIMENTS  ON  MAN  345 

"A  peculiar  coincidence  made  it  possible  for  the 
above-mentioned  colleague  to  carry  out  experiments 
in  connection  with  the  contagiousness  of  secondary- 
syphilis,  without  infringing  the  laws  of  humanity." 
These  experiments  consisted  of  the  following.^^ 
The  discharge  of  flat  moist  condylomata  and  the 
secretion  of  the  fissures  of  a  female  syphilitic  patient, 
were  inoculated  upon  eleven  persons — three  women 
of  1 7,  20  and  25  years  of  age  respectively,  and  eight 
men  of  ages  varying  from  18  to  28  years.  All  de- 
veloped syphilis.  The  pus  of  syphilitic  ulcers  was 
used  for  inoculating  three  women  of  24,  26  and  35 
years  of  age  respectively.  All  three  developed  syph- 
ilis. Sores  on  the  feet  of  six  patients  were  smeared 
with  blood  taken  from  a  syphilitic  patient;  three  of 
the  above  contracted  syphilis.  The  blood  of  a 
syphilitic  patient  was  introduced  into  the  wounds 
left  after  wet  cupping  of  three  persons.  There  was 
no  result.^^ 

Thus  twenty-three  persons  were  inoculated;  seven- 
teen of  these  developed  syphilis;  and  it  was  found 
possible  to  do  all  this  "without  infringing  the  laws 
of  humanity!"  Truly,  a  wonderful  coincidence! 
As  we  proceed,  we  shall  see  that  such  "coincidences" 
are  not  rare  in  syphilology.  .  .  .  The  identity  of 
the  author  of  these  experiments  never  transpired; 

26  Ibid. 

27  "Ausziige  aus  den  Protocollen  des  Vereins  pfalzlscher  Aerzte 
vom  Jahre  1855":  Aerztliche  Intellegenzhlatt,  1856,  No.  35,  pp.  425, 
426. 


346     THE  MEMOIRS  OF  A  PHYSICIAN 

he  found  it  best  to  keep  his  infamous  name  forever 
in  the  dark,  and  he  is  known  in  science  to  this  day 
as  the  ''Anonimus  of  Pfalz.'' 

The  same  question  of  the  contagiousness  of  sec- 
ondary syphilis  was  the  subject  of  the  researches  of 
Professor  H.  von  Hubbenet.  Among  others,  he 
made  the  following  experiments: — 

1.  "F.  Susikoff,  medical  orderly,  20  years  of  age, 
in  February,  1852,  underwent  inoculation  with 
mucous  papulse  of  a  syphilitic  patient,  while  in 
blooming  health.  I  blistered  his  left  thigh,  and, 
after  thus  removing  the  cuticle,  transferred  the  mat- 
ter of  the  mucous  papule,  by  means  of  a  spatula,  to 
the  raw  surface,  and  applied  lint  dressing  impreg- 
nated with  the  same  secretion.  .  .  .  Roseolse  ap- 
peared on  his  chest  and  abdomen  in  five  weeks. 
From  that  moment  the  syphilitic  affection  made 
rapid  progress.  I  kept  the  patient  in  this  condition 
for  a  week  longer,  to  enable  me  to  demonstrate  him 
before  as  large  a  number  of  physicians  as  possible, 
and  thus  allow  them  to  assure  themselves  of  the 
actuality  of  the  fact.  At  last  I  applied  the  mer- 
curial treatment,  and  the  patient  was  cured  in  three 
months." 

2.  "Private  Timothy  Maximoff,  33,  admitted  to 
the  surgical  clinic  on  January  13th,  1858,  suffer- 
ing from  an  inveterate  fistula  of  the  urethra.  As  ac- 
cording to  every  calculation  the  patient  was  to  re- 
main in  hospital  for  a  considerable  period,  and  there 


EXPERIMENTS  ON  MAN  347 

was  thus  sufficient  time  at  our  disposal  to  await 
results,  this  case  struck  me  as  being  a  suitable  one 
for  experiment.  On  March  14th,  inoculation  with 
the  matter  taken  from  the  ulcerated  tonsils  of  Pri- 
vate Nesteroff  was  performed.  ...  By  May  22nd 
characteristic  roseolse.  .  .  .  Mercurial  treatment 
started  on  June  2nd,  and  in  six  weeks  the  patient 
was  cured."  ^^ 

Commenting  upon  these  descriptions,  Professor 
V.  A.  Manassein  expresses  himself  as  follows :  "We 
do  not  know  what  to  be  more  amazed  at:  the  cold- 
blooded way  in  which  the  experimenter  allows  syph- 
ilis to  develop  more  acutely  for  the  purposes  of 
clearer  illustration  and  'so  as  to  show  the  patient  to 
a  larger  number  of  physicians';  or  at  that  logic  of 
the  superior,  which  permits  him  to  subject  a  sub- 
ordinate to  the  dangers  of  a  serious  and,  not  infre- 
quently, fatal  disease,  without  so  much  as  obtaining 
his  consent  thereto  I  I  should  very  much  like  to 
know  whether  Professor  Hubbenet  would  inoculate 
his  own  son  with  syphilis,  even  were  he  to  ac- 
quiesce !"  ^^ 

Professor  von  Hubbenet  concludes  his  article  with 
the  following  words :  "I  consider  it  necessary  to  re- 
mark that,  having  carried  out  a  multitude  of  ineffec- 
tive experiments  on  sick  persons,  I  was  perfectly  con- 
vinced that,  in  the  case  of  the  healthy,  I  would  meet 

28  Prof.  H.  V.  Hubbenet,  "Observations  and  Experiments  in  Syph- 
ilis": The  Medical-Military  Journal,  Part  77  (i860),  pp.  423-427. 
3^  "Lectures  on  General  Therapeutics,"  Part  i.    St.  P.  1879,  p.  66. 


348     THE  MEMOIRS  OF  A  PHYSICIAN 

with  the  same  lack  of  success:  this  conviction  alone 
made  it  possible  for  me  to  proceed  with  these  dan- 
gerous experiments."  Needless  to  say  that  a  pro- 
fessor and  specialist  could  not  have  been  ignorant 
of  Waller's  successful  inoculations.  Besides,  Prof. 
Hubbenet  performed  his  first  successful  inoculation 
in  1852,  while  his  last  dates  1858.  Are  we  to  be- 
lieve that  in  1858  the  professor  proceeded  with  his 
inoculations  full  of  the  same  "conviction"  ? 

The  publication  of  these  observations,  continues 
Hubbenet,  "will  perhaps  restrain  others,  even  with 
such  a  sceptical  nature  as  my  own,  from  making 
further  experiments,  often  leading  to  the  complete 
wrecking  of  the  lives  of  the  persons  subjected  to 
them.  It  would  add  considerably  to  my  peace  of 
mind  in  respect  to  the  victims'  fate,  if  these  experi- 
ments were  to  spread  the  conviction  that  the  second- 
ary stage  is  contagious.  If  they  lead  to  the  estab- 
lishing of  such  an  important  truth,  the  sufferings  of 
a  few  individuals  were  not  too  high  a  price  to  be 
paid  by  mankind  for  the  attainment  of  such  a  truly 
beneficial  and  practical  result." 

If  that  is  the  case,  it  is  hard  to  understand  why 
Professor  Hubbenet  did  not  inoculate  himself  with 
syphilis.  Perhaps,  after  all,  such  a  price  would 
have  been  too  high  to  pay  even  "in  the  cause  of  hu- 
manity." 

In  1858  the  French  Government  applied  to  the 
Parisian  Medical  Academy  for  elucidation  on  the 


EXPERIMENTS  ON  MAN  349 

still  contested  question  of  the  contagiousness  of  sec- 
ondary syphilis.  A  commission  was  nominated  and 
Dr.  Gibert  was  appointed  as  its  referee.  Among 
other  things,  he  stated  that  with  a  view  to  clear  this 
question  up,  Dr.  Auzias-Turenne  had  inoculated  two 
adult  patients  suffering  from  lupus,  and  that  both 
developed  syphilis. 

The  referee  himself  inoculated  two  patients,  also 
suffering  from  lupus,  and  in  both  cases  he  obtained 
syphilis.^^ 

Gibert's  report  gave  rise  to  stormy  and  lengthy 
debates  in  the  Academy;  Ricord,  who  had  hitherto 
obstinately  denied  the  contagiousness  of  secondary 
syphilis,  notwithstanding  overwhelming  confirma- 
tory evidence,  entered  the  lists  with  great  heat,  but 
was  compelled,  in  the  end,  to  confess  his  mistake, 
and  went  over  to  the  opposite  camp. 

Thus  the  most  powerful  and  authoritative  op- 
ponent of  the  new  view  taken  by  science  was  van- 
quished. But,  nevertheless,  experiments,  now  ab- 
solutely unwarrantable,  went  on  and  on.  ...  In 
1859  Guyenot  inoculated  T.  B.  B.,  a  boy  of  ten, 
suffering  from  sores  of  the  head,  with  the  secretions 
of  syphilitic  plaques,  and  obtained  syphilis.^^ 

In  the  same  year  Professor  Baerensprung  success- 

^^  Bulletin  de  V Academic  Imperiale  de  Medecine,  Tome  xxiv. 
Paris.     1858-1859,  pp.  888-890. 

31  '*Nouveau  fait  d' inoculation  d'accidents  Syphil.  Secondaires" : 
Gaz,  hebdomad,  de  med.  et  de  chirurgie,  1859,  No.  15.  Guyenot  was 
terribly  punished  for  his  experiment:  the  Tribunal  of  Correction  of 
Lyons  condemned  him  to  a  fine  of  one  hundred  francs! 


350    THE  MEMOIRS  OF  A  PHYSICIAN 

fully  incx:ulated  Bertha  B.,  a  girl  of  eighteen,  with 
syphilitic  pus.  It  was  also  he  who  inoculated  the 
prostitute  Marie  G.  with  the  secretions  of  hard 
chancre.^^ 

Prof.  Lindwurm,  in  1860-1861,  inoculated  five 
women  lying  in  his  hospital,  aged  18,  19,  30,  45 
and  71  years  respectively,  with  syphilis.  We  quote 
the  description  of  the  last  of  these  experiments: 
*'Mary  E.,  aged  71  years,  suffering  for  many  years 
from  an  extensive  and  deep  ulcer  in  the  forehead. 
Both  sinera  frontalia^  thanks  to  the  destruction  of 
the  front  walls,  are  open;  the  bottom  of  the  ulcer 
is  covered  deeply  with  granulations,  through  which 
the  probe  easily  reaches  the  bone,  and,  in  places, 
traverses  the  latter.  ...  On  May  27th,  1861,  the 
blood  of  a  syphilitic  patient  was  injected  subcutane- 
ously  between  the  shoulder  blades."  The  patient 
developed  syphilis.^^ 

According  to  Zeissel,  Dr.  Rosnerom,  acting  under 
Prof.  Hebra's  directions,  made  the  following  experi- 
ments: "(1)  The  secretion  of  a  flat  condyloma, 
located  on  the  breast  of  a  certain  wet-nurse,  was 
inoculated  upon  a  patient  of  50,  suffering  from 
acute  itch." — Syphilis.  (2)  A  wet-nurse,  suffering 
from  innocuous  syphilis,  was  inoculated  in  the  fore- 

32  "Mittellungen  aus  der  Klinik  fiir  syphil.  Kranke."  Annalen 
des  Charite-Krankenhauses,  Bd.  IX.  Heft  i    (i860),  pp.  167,  i68. 

33  "Uber  die  Verschiedenheit  der  syphilischen  Krankheiten": 
Wiirzburger  medicinische  Zeitschrift,  Bd.  III.  pp.  146-148,  174 
(1862). 


EXPERIMENTS  ON  MAN  351 

arm  with  chancrous  pus.  This  woman,  impregnated 
with  syphilis,  developed  characteristic  pustules. 
The  pus  of  the  latter  was  used  to  inoculate  a  certain 
leprous  patient,  who  had  not  previously  suffered 
from  syphilis.  .  .  .  This  inoculation  also  was  suc- 
cessful." '' 

Dr.  Puche  inoculated  a  patient  lying  at  the  Ho- 
pital  du  Midi^  in  the  ventral  regions,  with  the  secre- 
tion of  an  indurated  ulcer  of  a  syphilitic  patient, 
but  without  results.  Three  weeks  later  Puche  in- 
oculated his  victim  with  the  matter  of  another 
syphilitic.  This  time  the  experiment  was  crowned 
with  success :  the  patient  contracted  syphilis.^^ 

To  settle  the  question  once  and  for  all  whether  a 
person  who  had  once  had  syphilis  could  contract  it 
again.  Prof.  Vidal  de  Cassi  made  the  following  ex- 
periments. "M.,  age  37."  (Had  been  cured  of 
syphilis,  entered  hospital  with  paralysis  of  the  lower 
extremities,  formerly  employed  in  a  tannery  and 
afterwards  as  a  watchman.)  "The  patient  began 
to  recover  but  wished  to  remain  in  hospital  for  a 
certain  time  longer,  in  expectation  of  a  government 
post.  In  January,  1852,  small  blisters  were  applied 
to  each  thigh  because  of  the  inactivity  of  the  blad- 
der; when  the  skin  was  removed,  the  wounds  were 
dressed  with  lint  soaked  in  matter  taken  from  the 

^*  Herrmann  Zeissel,  "Guide  to  the  Study  of  General  Syphilis." 
St.  Petersburg,  1866,  page  29. 

35 Henry   Lee,    "Hunterian   Lectures   on   Syphilis":    The  Lancet, 
1875,  vol.  ii.  p.  123. 


352    THE  MEMOIRS  OF  A  PHYSICIAN 

mucous  papules  of  another  patient.  This  inocula- 
tion was  barren  of  results.  Later  I  proposed  that 
the  experiment  should  be  repeated.  On  April  I2th, 
1852,  when  the  patient  began  to  complain  of  diffi- 
culty in  breathing,  blisters  were  applied  to  the  upper 
parts  of  his  arms;  these  were  dressed  on  April  13th 
with  lint  saturated  in  the  pus  of  the  mucous  papules 
of  another  patient.  April  15th,  the  wounds  on  each 
arm  had  become  covered  with  a  greyish  membrane, 
suppuration  very  copious  and  of  disgusting  odour; 
lint  saturated  with  the  same  pus  as  previously  was 
freshly  applied  to  the  wounds,"  etc.^^  Vidal  was 
very  dissatisfied  with  the  squeamishness  of  those 
savants  who  did  not  venture  upon  such  experiments. 
"Unfortunately,"  he  remarks,  "the  cleverest  of 
syphilologists,  who  could  be  of  the  greatest  serv- 
ice to  science  thanks  to  their  logic  and  clinical  ob- 
servations, regard  experiment  as  immoral,  and  neg- 
lect it  accordingly."  ^^ 

Is  syphilis  contagious  in  the  tertiary  stage?  The 
majority  of  the  experiments  conducted  tend  to  nega- 
tive contagiousness.  Didet  inoculated  healthy  per- 
sons with  the  blood  of  syphilitic  patients  in  the  third 
stage  without  result.^^  Finger  performed  more  than 
thirty  inoculations  with  the  secretions  of  gummata 

3«Prof.  A.  Vldal,  "On  Venereal  Disease."  Transl.  from  the 
French,  St.  Petersburg,  1857,  pp.  560-561. 

37  Prof.  A.  Vidal,  "On  Venereal  Disease."  Transl.  from  the 
French.     St.  Petersburg,  1857,  p.  31. 

^^  Gaz.  Med,  de  Paris,  1846.  Cited  from  Lancereaux:  "The 
Study  of  Syphilis,"  p.  607. 


EXPERIMENTS  ON  MAN  353 

and  periostitae  upon  ten  healthy,  i.e.  non-syphilitic 
subjects.^^ 

A  long  series  of  experiments  were  conducted  by 
different  scientists  for  the  purpose  of  discovering 
whether  the  normal  and  pathological,  but  non-spe- 
cific, secretions  of  the  syphilitic  patient  in  the  sec- 
ond stage  were  contagious.  Thus  Basse  inoculated 
the  skin  of  a  healthy  person  with  gonorrhoeic  pus 
taken  from  a  syphilitic  patient,  with  negative  re- 
sult.^ ^  Profe  V.  M.  Tarnovsky  was  more  fortunate. 
"In  the  winter  of  1863,"  he  tells  us,  "in  the  Kalinkin 
Hospital,  after  eighteen  (  I)  attempts,  I  was  enabled 
to  inoculate  a  woman,  suffering  from  warty  growths, 
who  had  had  syphilis,  with  the  mucous-purulent  se- 
cretion of  another  patient"  (a  syphilitic  woman). 
Typical  syphilis  developed.^ ^ 

It  was  in  the  same  Kalinkin  Hospital  that  Pro- 
fessor Tarnovsky  conducted  a  series  of  experiments 
for  the  purpose  of  verifying  Cuillerier's  assertion 
that  soft  ulcer  cannot  be  transmitted  through  un- 
ruptured mucous  membrane.  .  .  .  "More  than  this," 
writes  the  professor,  "in  1868-1869  I  decided  to 
experiment  in  the  same  manner  with  the  discharge 
of  hard  chancre  and  that  of  the  subsequent  stages 
of  syphilis.     In  the  case  of  two  female  patients  who 

^^  E.  Finger,  "Die  Syphilis  und  die  venerische  Krankheiten." 
Wien,  1886,  p.  7. 

*°  Rollet's  speech  at  the  Congress  held  at  Lyons  in  1864.  Gaz. 
held.,  1864,  p.  706. 

*i  V.  M.  Tarnovsky,  "Course  of  Venereal  Diseases."  St,  Peters- 
burg, 1870,  p.  67, 


354     THE  MEMOIRS  OF  A  PHYSICIAN 

had  never  had  syphilis  and  absolutely  lacked  the 
slightest  abrasions  in  their  valvulse  .  .  .  the  secre- 
tion of  indurated  chancre  and  mucous  papules  was 
introduced  into  the  vagina  of  each."  Syphilis  did 
not  supervene.^  ^  By  the  way,  the  same  Prof.  Tar- 
novsky,  testing  Langleber's  preservative  fluid,  made 
the  two  following  experiments:  the  "secretion  of 
indurated  chancre  in  the  one  case,  and  that  of  moist 
mucous  papules  in  the  other,  was  transferred  upon 
the  inner  surface  of  the  upper  arm  of  a  healthy 
patient,  where  the  cuticle  had  been  previously  erased 
with  a  lancet.  The  infectious  matter  was  left  in 
contact  with  the  raw  surface  from  five  to  ten  min- 
utes, after  which  it  was  rubbed  with  the  preservative 
fluid.  In  neither  case  did  syphilitic  symptoms 
supervene."  ^^ 

In  the  spring  of  1897,  Professor  Tarnovsky  was 
superannuated  and  quitted  his  chair  at  the  Military 
Medical  Academy.  His  valedictory  lecture  was  de- 
voted to  .  .  .  medical  ethics.  The  professor  must 
have  given  expression  to  high-minded  and  noble 
sentiments,  for  the  students  accorded  him  a  loud 
ovation. 

Can  syphilis  be  transferred  through  the  agency  of 
the  secretions  of  the  soft  ulcer  of  a  syphilitic  pa- 
tient^    A.  G.  Gay,  lecturer  (now  professor)  of  the 

*2  Ibid.,  p.  64. 

*^  E.  Lancereaux,  "The  Study  of  Syphilis."  Translated  Into  the 
Russian  under  the  editorship  of  Prof.  V.  M.  Tairnovsky.  St,  Peters- 
burg, X876,  p.  669.    See  Editor's  note, 


EXPERIMENTS  ON  MAN  355 

Kazan  University,  essayed  to  clear  this  question  up 
by  experiment.  "The  experiment  was  performed 
upon  a  woman  suffering  from  Norwegian  leprosy 
who  had  never  had  syphilis  and  who  gave  her  con- 
sent for  the  experiment"   {sic!).     The  result  was 

44 
negative. 

The  results  of  four  inoculations  by  Rieger,  con- 
ducted by  him  in  Rinecker's  clinic,  were  also  nega- 
tive in  their  result.  Biedenkapp's  *^  experiments 
were  more  successful.  .  .  .  Ah,  no!  I  crave  his 
pardon;  one  of  those  magic  "coincidences" — quite 
improbable  in  everyday  life,  but  which,  as  we  know, 
occasionally  crop  up  in  syphilidology — came  to  his 
aid. 

"First  case :  A  young  girl,  admitted  October  9th, 
1862,  suffering  from  blenorrhoea  of  the  vagina  and 
the  urethra,  inoculated  herself,  by  means  of  a  needle, 
with  chancrous  virus  taken  from  the  artificial  ulcers 
of  a  female  patient  who  was  under  treatment  for 
syphilidisation.  .  ,  .  Two  ulcers  formed,  which 
were  not  accompanied  by  constitutional  syphilis." 

"Second  case:  A  young  girl  suffering  from  ec- 
zema of  the  forearms,  but  who  had  never  had  any 
venereal  affection,  inoculated  herself  out  of  mischiefs 
similarly  to  the  preceding  patient^  with  18  (eight- 
een ! )  chancres ;  to  these  were  added  1 2  more,  inocu- 

"**  "Diary  of  the  Physicians'  Society  of  Kazan,"  i88i,  p.  12. 

*5  See  Bumler's  "Syphilis"  in  the  "Guide  to  Special  Pathology 
and  Terapathy,"  by  Ziemssen.  Rus.  translation.  Vol.  III.  Part  i. 
p.  84.     Kharkoff,  1886. 


356    THE  MEMOIRS  OF  A  PHYSICIAN 

lated  as  a  test,  with  pus  from  the  original  pustules, 
as  the  cause  of  their  origin  was  not  at  first  known." 
The  patient  developed  syphilis.^^ 

For  the  sake  of  ascertaining  whether  the  milk  of 
women  suffering  from  syphilis  was  infectious,  Par- 
dowa  inoculated  four  healthy  wet-nurses  with  the 
milk  taken  from  a  syphilitic  patient;  in  each  case 
the  result  was  negative.^'^ 

The  same  question  was  the  subject  of  Dr.  R. 
Voss'  research.  In  the  Kalinkin  Hospital  he  in- 
oculated three  prostitutes,  '''having  obtained  their 
consent^''  with  the  milk  of  a  syphilitic  patient. 

First  experiment:  P.  A.,  aged  thirteen,  a  peas- 
ant from  the  Province  of  Novgorod ;  had  had  syphi- 
lis, but  was  cured.  On  September  25th,  1875,  the 
milk  of  a  syphilitic  patient  was  injected  into  her 
back.  The  only  result  was  an  abscess  the  size  of 
a  "small  fist." 

Second  experiment:  Natalie  K.,  age  fifteen, 
had  taken  up  prostitution  but  recently.  Admitted 
with  urethritis  and  vaginitis.  Milk  of  a  syphilitic 
patient  injected.     No  result. 

Third  experiment:  Lubov  U.,  age  sixteen,  a 
prostitute;  admitted  into  hospital  suffering  from 
urethritis;  never  had  syphilis.  September  27th,  a 
full  Pravaz  syringe  of  milk  from  a  syphilitic  patient 

*^  See  Bumler's  "Syphilis"  in  the  "Guide  to  Special  Pathology  and 
Terapathy,"  by  Ziemssen.  Rus.  translation.  Vol.  III.  Part  i.  p. 
84.     Kharkoff,  1886. 

■*'^  Lancereaux,  p.  614. 


EXPERIMENTS  ON  MAN  357 

injected  beneath  the  left  shoulder  blade.     The  girl 
developed  syphilis.^^ 

Dr.  Voss,  as  also  Prof.  Gay,  assures  us  that  his 
victims  gave  their  consent  to  these  experiments.  Is 
this  mockery*?  The  eldest  of  the  girls  was  but  six- 
teen years  of  age !  Even  if  their  consent  had  really 
been  obtained,  did  these  children  know  what  they 
were  agreeing  to,  could  any  importance  have  been 
attached  to  their  acquiescence  *? 

This  will  suffice.  I  have  mentioned  far  from  all 
the  facts  at  my  disposal,  dealing  with  the  inocula- 
tion of  syphilis  upon  man.  But  even  those  I  have 
adduced  seem  to  me  to  prove  convincingly  enough 
that  these  experiments  are  by  no  means  exceptional 
or  chance  occurrences*^:  they  are  conducted  sys- 
tematically, they  are  described  with  the  greatest 
sang  froid^  without  fear  of  being  condemned  by 
public  opinion,  as  if  it  were  but  a  matter  concerning 
dogs  and  rabbits.  In  conclusion,  I  will  only  quote 
a  few  more  experiments  from  other  spheres  of  medi- 
cine. Although  the  latter  are  comparatively  rarer 
(thanks  to  the  possibility  of  experimenting  upon 
animals),  nevertheless  their  absolute  number  is  more 
than  sufficient. 

While  investigating  the  channels  of  human  infec- 
ts <'Ist  die  Syphilis  durch  Milch  ubertragbar  ?"     5"/.  Petershurger 
med.  Wochenschrift,  1876,  No.  23.     In  the  original  all  three  girls 
were  named  in  full. 

*9This  was  true  enough  at  the  time  this  book  was  written  (1900) 
but  is  no  longer  so, 


358    THE  MEMOIRS  OF  A  PHYSICIAN 

tion  with  worms,  Professor  Grassi  and  Calandruccio 
administered  a  pill,  containing  the  germs  of  ascaris, 
to  a  boy  of  seven,  who  had  not  hitherto  suffered 
from  worms :  in  the  course  of  three  months  the  child 
evacuated  143  ascaris  of  lengths  varying  from  18 
to  23  centimetres  each.^^ 

At  the  medical  congress  held  in  Halle,  Professor 
Epstein  communicated  the  results  of  his  experiments 
in  the  same  direction:  the  germs  of  ascaris  were  ad- 
ministered to  three  children  in  their  food,  and  in 
three  months  their  excrements  contained  the  ova  of 
this  parasite.^  ^ 

Studying  diabetes  and  anxious  to  know  more  of 
the  changes  made  by  the  disease  in  the  liver,  Pro- 
fessors Frerichs  and  Erlach  punctured  this  organism 
with  a  trocar,  in  the  cases  of  various  patients.  "On 
removal  of  the  stiletto,  the  tube  of  the  trocar  was 
generally  found  to  contain  a  few  drops  of  blood 
with  liver  cells  and  occasionally  a  more  or  less  large 
sausage-shaped  piece  of  the  liver  itself."  ^^ 

Dr.  Fehleisen,  who  discovered  the  micro-organism 
of  erysipelas,  inoculated  an  old  woman  of  58,  suf- 
fering from  multitudinous  fibro-sarcoma  of  the  skin, 
with  a  culture  of  his  streptococci,  with  positive  re- 
sults.    ''On    the    sixth    day    after    inoculation    a 

^50  Prof.     B.     Grassi,    "Trichocephalus    u.    Ascarlsentwicklung": 
Centralbl.  fur  Bacteriol.  u.  Paras.,  1887,  Bd.  I.  p.  131. 

81  The  Physician.     St.  Petersburg,  1891,  p.  972. 

82  Prof.  Th.  V.  Freichs,  "Ubcr  den  Diabetes."  Berlin,  1884,  p. 
272. 


EXPERIMENTS  ON  MAN  359 

threatening  collapse  of  the  patient's  strength  set 
in,  which  necessitated  the  employment  of  stimu- 
lants." "' 

After  this  Fehleisen  inoculated  six  more  patients 
who  suffered  from  lupus  and  various  tumours,  with 
erysipelas.^^ 

In  March,  1887,  a  woman,  suffering  from  cancer 
of  the  mammary  gland,  applied  to  the  surgeon, 
Eugen  Hahn,  of  Berlin.  The  performance  of  an 
operation  was  impossible.  "Not  wishing  to  divulge 
before  the  patient  the  hopelessness  of  her  condition 
by  declining  to  operate  upon  her,  and  so  as  to  re- 
lieve and  reassure  her  by  the  psychical  illusion  of 
having  performed  the  operation,"  Dr.  Hahn  re- 
moved a  portion  of  the  tumour  of  the  patient's 
diseased  breast  and  .  .  .  transplanted  it  into  the 
other  healthy  one;  the  inoculation  was  success- 
ful.^^ 

^^  Dr.  Fehleisen,  "Die  Aetiologie  des  Erysipels."  Berlin,  1883, 
pp.  21-23. 

^*  Op.  cit.  p.  29.  Essaying  to  vindicate  his  experiments,  Dr. 
Fehleisen  makes  mention  of  the  alleged  beneficial  action  of  erysipe- 
las in  cases  of  malignant  tumours  and  lupus,  as  observed  by  certain 
savants.  He  mentions  his  experiments  on  a  man  of  twenty,  who 
suffered  from  lupus  for  the  last  twelve  years  and  had  erysipelas 
many  times.  What  were  Fehleisen's  grounds  for  expecting  that  ery- 
sipelas, inoculated  by  him,  should  heal  a  patient  that  had  many  times 
been  attacked  by  that  disease  without  deriving  any  benefit  from  it? 
"Desirous  of  discovering  whether  an  individual,  after  having  had 
the  disease,  retains  immunity  for  a  certain  length  of  time,"  Fehlei- 
sen inoculated  a  little  girl  of  eight  for  the  second  time  with 
erysipelas. 

55  E.  Hahn,  "Ueber  Transplantation  der  carcin.  Haut."  Berlin, 
kiln,  Woch,  1888,  No.  21, 


36o     THE  MEMOIRS  OF  A  PHYSICIAN 

Thus  the  very  important  fact  that  it  was  possible 
to  inoculate  cancer  was  definitely  proved. 

Subsequently  Professor  Bergmann  successfully 
repeated  Dr.  Hahn's  experiment,  and  an  anonymous 
surgeon  did  likewise,  sending  his  communication  on 
the  subject  to  the  Parisian  professor  Cornil. 

Dr.  N.  A.  Finn  studied  the  question  of  the  infec- 
tiousness of  typhoid  fever  in  one  of  the  military 
hospitals  of  the  Caucasus.  Following  his  instruc- 
tions, assistant  house-physician  Artemovitch  injected 
the  blood  of  typhoid  patients  subcutaneously  into 
the  systems  of  seventeen  healthy  soldiers.  Not  one 
of  those  inoculated  contracted  the  disease;  "only  ten 
of  them  developed  ordinary  abscesses  at  the  places 
of  puncture."  In  addition,  twenty-eight  young  and 
healthy  soldiers  were  placed  by  Dr.  Finn  in  the  same 
ward  with  typhoid  patients.  They  lay  in  hospital 
in  the  vicinity  of  the  sick,  "for  four  or  five  days, 
the  beds  being  moved  close  together,  and  sometimes 
they  were  covered  with  the  blankets  of  the  typhoid 
patients."  ^^ 

During  December,  1887,  Dr.  Stickler  read  a  pa- 
per before  the  Academy  of  Medicine  of  New  York 
on  preventive  inoculation  against  scarlet  fever.  He 
had  observed  that  persons  who  had  contracted  hoof 
and  other  kindred  diseases  from  the  lower  animals, 
became  immune  to  scarlet  fever.     To  verify  his  ob- 

5«  The  minutes  of  the  meetings  of  the  Imperial  Caucasian  Medical 
Society  for  1878-1879,  No.  8,  p.  107.  Drs.  Finn  and  Artemovitch 
also  injected  the  blood  of  typhoid  patients  into  their  oivn  systems. 


EXPERIMENTS  ON  MAN  361 

servations,  Stickler  inoculated  children  with  the 
blood  of  sick  horses  and  cows.  After  this  he  placed 
the  children  on  bedding  which  had  been  in  the  use 
of  scarlet  fever  patients  and  made  them  inhale  the 
air  exhaled  by  the  latter;  these  children  numbered 
twenty.  Stickler  also  injected  the  blood  of  scarlet 
fever  patients  into  the  systems  of  the  twenty  chil- 
dren. Of  their  number  several  did  not  take  the 
fever  at  all,  the  rest  developed  it  in  very  mild  form ; 
there  were  no  serious  cases.^"^ 

Professor  Roberts  Bartholow  of  Ohio,  U.  S.  A., 
attended  a  female  patient,  the  posterior  part  of 
whose  cerebrum  had  become  exposed,  owing  to  can- 
cer of  the  cranial  integuments.  The  professor  took 
advantage  of  this  rare  case  for  the  purpose  of  con- 
ducting a  series  of  experiments  of  electric  irritation 
of  his  patient's  brain.  Galvanic  irritation  of  the 
dura  mater  proved  to  be  painless,  while  faradic  cur- 
rent caused  muscular  contraction  throughout  the 
opposite  side  of  the  body.  After  this  he  "passed 
an  isolated  needle  into  the  left  posterior  lobe;  the 
other  isolated  needle  was  placed  in  contact  with  the 
dura  mater.  When  the  circuit  was  closed,  muscu- 
lar contractions  of  the  right  upper  and  lower  ex- 
tremities ensued;  faint  but  visible  contractions  of 

^■^  Summary  of  Stickler's  paper,  as  it  appeared  in  one  of  the  Amer- 
ican medical  journals.  The  Centralblatt  fiir  Bacteriologie  u. 
Parasitenkunde,  Bd.  IV.,  1888,  p.  369,  remarks:  "The  results  ob- 
tained are,  in  any  case,  sufficiently  important  to  encourage  further 
research  in  the  same  direction," 


362     THE  MEMOIRS  OF  A  PHYSiaAN 

t±ie  left  orbicularis  palpebrarum  and  dilation  of  the 
pupils  also  ensued.  Notwithstanding  the  very  evi- 
dent pain  from  which  she  suffered,  she  smiled  as  if 
amused." 

The  same  experiment  was  repeated  upon  the  right 
cerebral  hemisphere.  "When  the  needle  entered 
the  brain  substance  she  complained  of  acute  pain  in 
the  neck.  In  order  to  develop  more  decided  reac- 
tions, the  strength  of  the  current  was  increased. 
When  communication  was  made  with  the  needles, 
her  countenance  exhibited  great  distress,  and  she  be- 
gan to  cry.  Her  eyes  became  fixed,  with  pupils 
widely  dilated,  lips  blue,  and  she  frothed  at  the 
mouth.  She  lost  consciousness  and  was  violently 
convulsed  on  the  left  side.  The  convulsion  lasted 
five  minutes,  and  was  succeeded  by  coma.  She  re- 
turned to  consciousness  in  twenty  minutes  from  the 
beginning  of  the  attack."  After  the  lapse  of  a  cer- 
tain time  the  experiment  was  repeated  once  more 
with  a  weaker  current,  and  three  days  later  her  con- 
dition was  decidedly  worse.  In  the  evening  she 
"had  a  convulsive  seizure,  lasting  about  five  min- 
utes. After  this  attack  she  relapsed  into  profound 
unconsciousness  and  was  found  to  be  completely 
paralysed  on  the  right  side." 

The  unfortunate  woman  died  soon  afterwards. 
According  to  Professor  Bartholow's  opinion  her 
death  was  caused  by  the  original  disease.^^ 

^^See  British  Medical  Journal,  1874,  vol.  i.  p.  687.     In  review- 


EXPERIMENTS  ON  MAN  363 

"So  this  is  how  the  doctors  treat  those  patients 
who  place  their  health  in  the  hands  of  the  faculty  I" 
some  readers  will  exclaim,  on  finishing  this  chapter. 
Such  a  deduction  were  entirely  mistaken.  The  ex- 
istence of  a  few  hundred  doctors,  to  whom  the  sick 
are  merely  so  many  objects  for  experiment,  does  not 
justify  the  branding  of  the  entire  profession.  As  a 
parallel,  I  might  bring  forward  a  no  less  array  of 
facts,  which  would  show^  that,  in  the  past,  doctors 
have  conducted — and  continue  to  do  so  now — no 
less  dangerous  experiments  upon  their  own  persons. 
Thus,  Pettenkoffer's  and  Emerich's  experiments  are 
still  fresh  in  the  memory  of  all:  both  swallowed 
pure  cultures  of  cholera  bacilli,  after  having  had  the 
acids  of  the  stomach  neutralised  with  soda.  This 
was  repeated  by  Professor  Metschnikoff,  Drs.  Ras- 
ing the  above  communication  which  appeared  in  an  American  con- 
temporary, the  British  Medical  Journal  censured  the  author  for 
his  experiments.  Bartholow  wrote  a  letter  to  the  editor,  in  which 
he  sought  to  vindicate  his  action  by  remarking  that  his  patient 
was  bound  to  die  very  soon  and  that  she  had  agreed  to  the  ex- 
periments, which,  according  to  his  opinion,  presented  no  danger. 
"Notwithstanding  my  sanguine  expectation  that  small  isolated 
needle  electrodes  could  be  introduced  without  injury  into  the  cere- 
bral substance,"  wrote  the  professor,  "I  now  know  that  I  was  mis- 
taken. To  repeat  such  experiments  with  the  knowledge  we  now 
have  that  injury  will  be  done  by  them,  would  be  in  the  highest  de- 
gree criminal.  I  can  only  now  express  my  regret  that  facts  which  I 
hoped  would  further,  in  some  slight  degree,  the  progress  of  knowl- 
edge, were  obtained  at  the  expense  of  some  injury  to  the  patient." 
According  to  the  journal's  opinion,  this  letter  was  "one  which  is 
likely  to  disarm  further  criticism,"  and  the  editor  found  it  both  sin- 
cere and  worthy  of  the  author's  profession,  and  even  .  .  .  humane 
(p.  728).  All  this  was  said  without  a  trace  of  irony.  On  the 
whole,  however,  Bartholow's  experiments  aroused  the  indignation  of 
the  entire  medical  press. 


364     THE  MEMOIRS  OF  A  PHYSICIAN 

terlick  and  Latapie.  Drs.  Borgioni,^^  Warneri,®^ 
and  Lindemann,^^  and  many  others,  inoculated  them- 
selves with  syphilis;  young  and  healthy,  in  the  name 
of  Science,  they  faced  experiments  which  crippled 
and  ruined  their  entire  lives.  To  conclude  that  the 
entire  medical  body  is  made  up  of  heroes,  because  a 
few  devoted  men  martyred  themselves  in  the  name 

59  On  Feb.  6th,  1862,  Prof.  Pellizzari  inoculated  Drs.  Borgioni, 
Rosi  and  Passigli  with  the  blood  of  a  syphilitic  patient  after  they 
had  "courageously  given  themselves  up  to  be  experimented  upon, 
notwithstanding  the  professor's  remonstrances."  The  inoculation 
of  Dr.  Borgioni  was  successful:  two  months  after  it  had  been  per- 
formed he  began  to  suffer  from  nocturnal  headaches,  general  rash 
appeared,  as  well  as  swelling  of  the  glands;  ten  days  later  the 
primary  ulcers  on  the  hands  began  to  heal,  and  it  was  only  then 
that  Dr.  Borgioni  submitted  to  mercurial  treatment  {Gaz.  hehdom. 
1862,  No.  22,  pp.  349-350)- 

^0  Verhandlungen  der  phys.  med.  Gesellschaft  in  Wurzburg,  Bd. 
iii.  (1852),  p.  391.    Article  by  Prof.  Rinecker. 

61  Being  interested  in  the  different  questions  of  syphilidology,  Dr. 
LIndemann  made  the  following  experiment  upon  his  own  person. 
In  the  course  of  two  months  he  inoculated  himself  upon  the  hands 
with  soft  ulcer,  at  intervals  of  five  days;  three  months  later  he 
inoculated  himself  with  the  secretions  of  a  syphilitic  patient  and  de- 
veloped the  disease.  Seventeen  days  after  the  appearance  of  the 
papular  eruption,  Lindemann  again  began  to  inoculate  himself  with 
chancres  of  varying  malignity.  The  commission  appointed  by  the 
Medical  Academy  of  Paris  to  examine  Dr.  Lindemann,  reported 
upon  his  condition  through  the  medium  of  its  referee,  Dr.  Beguin,  in 
the  following  terms:  "Both  arms  (from  shoulder  to  palm)  are  cov- 
ered with  sores;  many  of  the  ulcers  are  confluent,  they  are  sur- 
rounded by  acute  and  painful  inflammation ;  suppuration  is  very 
abundant;  the  bottom  of  most  of  the  ulcers  is  of  a  greyish  hue;  to 
sum  up,  all  these  injuries — to  use  a  surgical  term — have  a  very  bad 
aspect.  The  whole  body  is  covered  with  an  abundant  eruption  of 
syphilitic  papules.  Dr.  Lindemann  is  full  of  courage  and  confidence 
and  expressed  his  intention  of  at  least  applying  himself  to  the  regu- 
lar treatment  of  his  disease,  which  has  become  inveterate  and 
serious."  {Bulletin  de  VAcademie  Nationale  de  medecine,  Tome 
xvii.    Paris,  1851-1852,  pp.  879-885), 


EXPERIMENTS  ON  MAN  365 

of  Science,  were  as  erroneous  as  to  write  all  doctors 
down  brutes,  callous  of  their  patients'  interest,  in 
consequence  of  the  comparative  few  having  con- 
ducted criminal  experiments  as  described.  But  the 
latter  establish  one  thing  beyond  all  vestige  of  a 
doubt — and  that  is  the  shameful  indifference  with 
which  the  medical  world  contemplates  such  atroci- 
ties. For  this  martyrology  of  the  unhappy  patients 
offered  up  as  victims  to  science  was  not  compiled  by 
any  underhand  means— the  culprits  publicly  blaz- 
oned their  own  infamy/  in  black  and  white.  One 
would  suppose  that  the  mere  fact  of  publication  of 
such  experimicnts  would  make  their  repetition  ut- 
terly impossible,  the  first  to  attempt  anything  of  the 
kind  being  cast  forever  from  the  medical  corpora- 
tion! But,  unfortunately,  this  is  not  so.  With 
heads  proudly  erect,  these  bizarre  disciples  of  science 
proceed  upon  their  way  without  encountering  any 
effective  opposition,  either  from  their  colleagues  or 
the  medical  press.  Of  all  the  organs  of  the  latter,  I 
know  of  only  one  which  stoutly  and  energetically 
protests  against  every  experiment  on  the  living  hu- 
man creature — and  that  is  the  Russian  journal 
Physician,  which  was  edited  until  recently  by  Prof. 
Manassein,  lately  deceased.  Upon  the  pages  of 
that  journal,  notices  such  as  the  following  are  al- 
ways in  evidence:  ''Once  more  impermissible  ex- 
periments!" "We  are  utterly  at  a  loss  to  under- 
stand how  doctors  can  permit  themselves  to  perform 


366    THE  MEMOIRS  OF  A  PHYSICIAN 

such  experiments  I"  ''Must  we  really  wait  until 
the  public  prosecutor  takes  upon  himself  the  task  of 
indicating  the  line  where  legitimate  experiment 
stops  and  the  criminal  commences^"  "Is  it  not 
time  for  doctors  to  unite  and  rise  up  in  revolt  against 
such  experiments,  no  matter  how  instructive  they 
may  be?" 

Emphatically,  yes! 

It  is  time,  high  time!  But  the  moment  has  also 
arrived  for  society  to  take  its  own  measures  of  self- 
protection  against  those  zealots  of  science  who  have 
ceased  to  distinguish  between  their  brothers  and 
guinea-pigs,  without  waiting  for  the  faculty  to 
emerge  from  its  lethargy. 


AUTHOR'S  POSTSCRIPT 

"Is  it  possible  that  there  is  no  voice  in  your  mother's  heart, 
which  forbids  you  to  destroy  your  son's  ideals^" 

"But  what  will  then  become  of  truths"  ' 

"What  will  then  become  of  ideals  *?" 
"Oh  I  ideals,  ideals !  .  .  ." 

Ibsen  :     "Ghosts." 

THESE  "Memoirs"  have  brought  down  upon 
me  a  storm  of  indignation  emanating  from  a 
certain  section  of  my  readers.  How  could  I  have 
the  hardihood  to  expose  with  such  unreserved  can- 
dour in  the  press  and  before  the  laity  all  that  a  doc- 
tor has  to  go  through?  What  could  my  aim  have 
been  in  so  doing?  Ought  I  not  to  have  known  that 
a  great  distrust  in  medicine  and  in  doctors  exists 
in  the  public  mind  as  it  is?  Such  an  exposure  as 
that  furnished  by  my  "Memoirs"  could  only  serve 
to  strengthen  this  distrust.  The  cheap  news- 
papers, which  constantly  run  the  doctors  down, 
would  pounce  with  glee  upon  the  material  I  had 
provided,  to  make  use  of  it  for  the  furtherance  of 
their  own  obscure  ends.  Rumours  might  reach  the 
lower  strata  of  society — the  ignorant  masses — and 
estrange  them  from  medicine,  in  the  assistance  of 
which  they  stand  in  such  pressing  need.  The  au- 
thor— ^himself    a    medical    man — ought    to    have 

367 


368    THE  MEMOIRS  OF  A  PHYSICIAN 

realised  what  he  was  about,  when  thus  starting  to 
undermine  the  confidence  of  the  public  toward  both 
doctors  and  medicine. 

This  outburst  of  indignation  struck  me  as  very 
significant.  All  of  us  fear  the  truth  so  much,  we 
are  so  little  conscious  of  its  necessity,  that  it  suffices 
to  lay  bare  its  smallest  corner — and  people  begin  to 
feel  uneasy.  "Why"?  What  good  can  it  do*? 
What  will  the  uninitiated  say"?  What  construction 
will  they  put  upon  the  truth,  as  offered  them*?" 

From  the  moment  of  my  matriculating  at  the 
University  Medical  School,  and  more  especially, 
of  my  taking  up  practice,  one  by  one  all  manner 
of  questions  began  to  arise  before  me,  each  more 
complicated  and  more  difficult  than  its  predecessor. 
I  sought  their  answer  in  my  medical  books  and  in 
the  medical  press — and  found  it  nowhere.  Medical 
ethics  were  elaborating,  painstakingly  and  pe- 
dantically, a  tiny  circle  of  petty  questions  dealing 
with  the  rules  which  regulate  the  attitude  of  doc- 
tors towards  their  patients  and  towards  each  other. 
But  all  the  problems  which  confronted  me  hardly 
existed  for  them.  Why^  .  .  .  Was  it  really  neces- 
sary to  be  endowed  with  extraordinary  perspicacity 
and  sensitiveness  to  be  able  to  note  and  raise  the 
questions  which  I  touch  upon  in  my  "Memoirs'"? 
Why,  every  medical  man  is  assailed  by  them,  they 
torment  every  doctor  who  has  not  yet  retired  into 
the  shell  created  by  affluence  or  the  ease  of  an  as- 


AUTHOR'S  POSTSCRIPT  369 

sured  position.  Why  then  does  no  one  discuss 
them,  why  should  each  be  compelled  to  seek  their 
answer  single-handed? 

It  seems  to  me  that  there  can  be  but  one  ex- 
planation: all  fear  that  if  such  questions  be  stirred 
up  and  made  the  subject  of  open  discussion,  the  pub- 
lic's confidence  in  the  profession  might  suffer.  Ac- 
cordingly, an  impenetrable  veil  is  cast  upon  the  most 
serious  and  burning  problems  of  the  physician's  art, 
and  they  are  studiously  ignored — as  if  entirely  non- 
existent. And  in  the  meanwhile  this  systematic 
hushing-up  has  worked  much  evil  and  continues  to 
do  so.  Thanks  to  it  there  is  an  absence  of  that 
which  is  most  important  of  all — of  an  all-pervading 
atmosphere  pregnant  with  the  consciousness  that 
these  problems  still  remain  unsolved,  and  that  their 
clearing  up  is  of  the  most  pressing  necessity. 
These  questions  are  settled  in  solitude  and  in  secret, 
this  way  or  that.  Often  they  find  the  wrong  an- 
swer, and  more  often  still,  are  stifled  without  any 
answer  being  given  them  at  all.  I  have  had  oc- 
casion to  hear  contentions  of  such  a  nature  put  for- 
ward by  my  colleagues,  in  regard  to  my  * 'Memoirs," 
that  I  simply  cannot  bring  myself  to  quote 
them — so  extraordinarily  grotesque  and  profession- 
ally egoistical  are  they;  and  nevertheless  I  have  had 
to  listen  to  them  from  many  quarters.  "  I  think  that 
such  objections  could  only  have  been  generated  from 
that  dense,  voiceless  murk,  in  which  the  mind  only 


370     THE  MEMOIRS  OF  A  PHYSICIAN 

begins  to  quicken  when  it  stumbles  right  up  againsc 
a  question;  and  under  these  circumstances,  it  is  vain 
to  expect  the  embracing  of  a  problem  with  anything 
like  breadth  of  grasp. 

Others  have  queried:  *'If  you  considered  it 
necessary  to  raise  these  questions,  why  did  you  not 
make  use  of  the  medical  press,  why  did  you  lay  bare 
your  doubts  before  the  lay-mind'?  The  lay-mind  is 
incapable,  in  any  case,  of  finding  an  answer  to  them. 
Moreover,  it  ought  to  remain  in  ignorance  of  the 
very  existence  of  such  questions  I" 

In  the  Middle  Ages  a  certain  physician  of  Worms, 
Rosslin  by  name,  published  a  medical  work  in  Ger- 
man, not  in  Latin  as  was  the  custom  in  those  days. 
Thoroughly  conscious  of  the  enormity  of  such  a 
"profanation"  of  his  science,  he  excused  himself  be- 
fore his  readers  in  his  preface,  and  earnestly  begged 
them  to  keep  his  book  well  under  lock  and  key,  "to 
prevent  its  falling  into  the  hands  of  the  uninitiated, 
that  thus  pearls  should  not  be  cast  before  swine."    • 

These  times  have  long  passed  into  oblivion.  The 
professional  press  makes  exclusive  use  of  the  idiom 
of  the  country  it  belongs  to,  the  idiom  understood 
by,  and  intelligible  to,  every  "uninitiated"  person. 
It  would  not  have  altered  matters  one  jot  even  if  I 
had  put  my  "Memoirs"  into  less  popular  lan- 
guage and  published  them  in  a  professional  pe- 
riodical— in  any  case  the  press  at  large  would  not 
have  failed  to  extract  and  make  all  that  was  "ia- 


AUTHOR'S  POSTSCRIPT  371 

teresting"  general  property.  Only  it  would  have 
been  enabled  to  serve  the  facts  according  to  its  own 
tastes  and  illuminate  them  in  its  own  way — per- 
haps inaccurately  and  ignorantly. 

Anyhow,  the  kernel  of  the  nut  lies  elsewhere: 
why  should  the  man  in  the  street  remain  ignorant 
of  those  questions'?  To  whom  and  by  whom  was 
the  right  given  to  play  guardian  to  him?  By  all 
means  let  judges,  school-m.asters,  literati^  lawyers, 
engineers  and  police  inspectors  publish  their 
memoirs ! 

If  I  were  told  that,  as  an  outsider,  I  ought  not  to 
be  introduced  to  the  hidden  aspects  of  the  profes- 
sions enumerated,  I  would  answer  that  not  being  a 
child,  I  was  fully  competent  to  judge  for  myself  of 
what  was  good  for  me  and  what  v/as  not.  "On 
learning  the  truth  the  lay-person  may  lose  his  or  her 
confidence  in  medicine  and  its  exponents."  .  .  . 
How  strange  that  that  old,  old  rotten  fallacy  should 
still  be  countenanced — the  stifling  of  publicity  for 
fear  of  the  truth  shaking  established  authority  I 
As  if  it  were  possible  to  create  a  box  strong  enough 
to  keep  Truth  a  voiceless  captive  I  You  may  use 
the  stoutest  iron  bars  to  bind  your  box  with,  but  it 
will  start  at  every  seam  and  joint,  and  the  truth  will 
ooze  out — distorted,  mutilated,  disjointed,  irritating 
in  its  incompleteness,  and,  for  that  reason,  leading 
one  to  suspect  the  very  worst.  Doctors  carefully 
guard  the  public  from  all  that  may  shake  its  faith 


372     THE  MEMOIRS  OF  A  PHYSICIAN 

in  medicine,  and,  pray,  what  is  the  result?  Is  the 
confidence  of  the  public  very  great*?  Is  not  the 
public  ever  on  the  alert  to  seize  upon  the  most 
grotesque  gossip  regarding  the  faculty,  does  it  not 
proffer  the  most  absurd  accusations  and  demands'? 
At  certain  times,  in  serious  cases,  it  is  occasionally 
necessary  to  deceive  the  patient  for  his  own  good; 
but  society  at  large  is  not  an  invalid,  and  momen- 
tary mendacity  should  not  be  elevated  into  an  eter- 
nal principle. 

One  of  the  two:  either  the  truth  can  lessen  our 
faith  in  medicine  and  doctors,  because  medicine  is 
in  itself  unworthy  of  our  confidence — in  that  case 
the  truth  is  beneficial  (nothing  is  more  harmful 
nor  causes  so  much  disillusion  as  exaggerated  faith 
in  anything).  Or  else,  the  truth  is  capable  of  shak- 
ing faith  in  doctors  because  it  exposes  the  seamy 
side  of  their  profession,  which  can  be,  but  is  not, 
remedied — in  that  case  the  truth  is  indispensable; 
for  if  the  dark  sides  were  obliterated,  confidence 
would  spring  up  once  more.  But  until  this  is  ac- 
complished, complete  faith  were  out  of  place.  And 
here  I  repeat  once  more  what  I  have  already  said 
in  my  "Memoirs":  that  personally  I  would  never 
apply  to  a  doctor  fresh  from  the  student's  bench, 
would  not  submit  myself  to  a  surgeon  who  was 
about  to  perform  his  first  operation,  would  not  allow 
my  child  to  take  a  new,  little-known  medicine,  nor 
would  I  permit  of  its  being  inoculated  with  syphilis. 


AUTHOR'S  POSTSCRIPT  373 

And  I  believe  that  no  other  doctor,  in  his 
turn,  would  act  differently.  Once  this  fact  is  es- 
tablished, how  dare  one  hide  all  this  from  the  "out- 
sider," how  dare  one  leave  him  to  face  that  which 
the  "initiated"  would  most  sensibly  declined 

It  is  perfectly  true  that  the  lay-public  is  not  in  a 
position  to  find  the  true  answer  to  these  problems. 
But  it  has  every  right  to  demand  that  a  solution  be 
discovered,  and  its  interest  in  these  questions  is  per- 
fectly legitimate ;  they  concern  the  public  too  closely. 
Further  still — the  public  discussion  of  these  ques- 
tions is,  in  my  opinion,  the  only  guarantee  of  their 
being  satisfactorily  answered.  If  this  task  were  left 
to  doctors  alone,  they  might  easily  err,  to  a  greater 
or  lesser  degree,  in  the  direction  of  one-sidedness. 

lYet  another  accusation  is  levelled  against  me.  A 
certain  much-read  medical  journal  affirms  that  I 
"generalise  single  facts  of  medical  practice  in  an  un- 
justifiable manner,"  and  that  "for  some  unknown 
reason"  I  permit  myself  "undoubted  exaggerations 
and  lay  my  paints  on  too  thickly."  Of  course,  such 
an  accusation  calls  for  the  most  serious  considera- 
tion; but  unfortunately,  it  is  not  formulated  with 
any  further  preciseness,  and  therefore  a  rejoinder 
becomes  a  rather  difficult  task. 

That  such  accusations  would  be  made  against  me 
I  foresaw  from  the  very  beginning,  and  it  was  for 
this  reason  that  I  took  pains  to  supply  my  text  with 
abundant  and  exhaustive  quotations,  which  appeared 


374     THE  MEMOIRS  OF  A  PHYSICIAN 

to  me  to  be  sufficiently  characteristic  and  convincing 
— to  the  direct  detriment  of  the  literary  merit  of  my 
essay.  As  a  matter  of  fact,  I  have  even  been  re- 
proached by  the  general  press  of  "going  into  too 
great  detail,"  and  am  told  that  my  "Memoirs" 
occasionally  "assume  the  character  of  a  professional 
article  in  a  medical  journal."  If  I  do  not  adduce 
further  substantiation  of  the  correctness  of  my 
"Generalisations,"  this,  at  any  rate,  can  in  no  case 
be  put  down  to  a  lack  of  the  necessary  material. 

The  Author. 


.THE    END 


— SEf 


DATE  DUE 


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